Developmental outcomes, transfers and severe brain injury
At the time of protocol writing, we considered that the 2-year follow-up recorded in the routinely collected EPRs was inadequate for robust unbiased assessment. There were no other reliably collated retrospective records for later developmental assessment into school years and beyond, for our cohort.
Now that we have identified that one in three babies born very preterm in the OPTI-PREM cohort are transferred at some stage of their neonatal stay, it becomes important to understand the impact of the transfers overall on the development and outcomes of very preterm babies, and their impact on families. SBI may represent only one extreme of the spectrum; the developmental aspects associated with early transfers in very preterm babies are unexplored.
Cost analysis
Societal costs of care
The societal cost of care to babies, families and society, for babies born very preterm between 27 and 31 weeks gestation, is unclear. We need to research this so that adequate resources and avenues for support for families can be set aside. These will contribute to optimising the delivery of care for these vulnerable babies, and families.
Cost savings of preventing severe brain injury
Having defined the impact of postnatal transfers at 27 weeks gestation, on SBI, the cost savings for the NHS of preventing these with antenatal triage should be calculated. This is important to define, to inform costs of reorganisation of services for support for maternity centres colocated with NICU, and their NICU, for anticipated preterm births at 27 weeks gestation.
The costs and effects of care using outcomes of key morbidities as opposed to mortality may guide optimisation of services, together with and evaluation of the impact of serious morbidities such as SBI on long-term quality of life for families and individuals born very preterm at 27–31 weeks gestation.
Costs of care for high-performing units compared with lower-performing units
OPTI-PREM has begun to uncover potential health economic cost benefits of caring for these very preterm babies in higher-performing units (shorter duration of hospital stay, hence lower NHS hospital cost). This should be explored in conjunction with further research on quality of care for very preterm babies.
Cost-effectiveness of evidence- and consensus-based interventions to reduce key morbidities in very preterm neonatal care
We have the framework in place for future cost and effects analysis for key morbidities in very preterm babies. Understanding the cost of neonatal complications in very preterm babies in England, and the cost effects of current practices will provide the scientific evidence to more effectively be able to channel resources for cost-effective neonatal health care in England.
Quality of care research
The quality of care observations in OPTI-PREM could drive further research into consolidating these using national benchmarks and targets, and with the NNAP. We believe that such research on quality of care should be conducted against robust outcome measures, partly addressed in OPTI-PREM. Except for OPTI-PREM, and earlier work supporting OPTI-PREM observations,11 this has not been described in very preterm babies.
Basic science and clinical studies of risks of postnatal transfer
The high rate (one in three) of postnatal transfers in this cohort supports that we should be proactive in optimising the transport process itself, to limit any known and as yet undefined dangers posed by the transport of very preterm babies pose. We are unlikely to be able to avoid transporting babies between units completely, due to the nature of babies being born early, their illness, capacity, and need for specialised services that only a few centres can provide etc. Optimising transport processes is a key element of optimising health service delivery for very preterm babies.