Research

For transported preterm infants, IVH tracked early instability—not journey time

NICU360 Evidence Desk·7 min read·00

In one retrospective cohort of 286 outborn infants born before 32 weeks, IVH was present in 19.9% on day 1. Mode, duration and measured transport intervals were not associated with IVH; perinatal inflammation and markers of early instability were. The operational focus may need to start before departure—but the data do not prove the ride is harmless.

THE HOT TAKE

The measured journey variables went quiet; the physiology around birth did not.
— NICU360 Evidence Desk

Published in BMJ Open on 1 September 2026, this Western Australian retrospective cohort included infants born before 32 weeks outside the state’s sole tertiary perinatal centre and transported by NETS WA on day 1 between 2011 and 2021. Of 10,473 transported infants, 297 were born before 32 weeks; 11 had congenital anomalies or died before the first scan and were excluded, leaving 286 for the day-1 analysis.

Routine cranial ultrasound found any IVH in 57/286 infants on day 1 and severe IVH in 25/286. Eleven infants died before the day-7 scan. Among the remaining 275, any IVH was present in 53 and severe IVH in 27.

IVH recorded on routine cranial ultrasound (%)

Day 1 (n=286)

Day 7 (n=275)

Any IVHGrade III–IV

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Exposure	Day 1 OR (95% CI)	Day 7 OR (95% CI)
Intra-amniotic inflammation or PPROM	2.47 (1.10–5.44)	1.25 (0.50–2.92)
Epinephrine during resuscitation	4.88 (1.49–17.5)	2.31 (0.63–8.33)
Inotropes during transport	7.85 (1.35–54.6)	9.11 (1.32–72.9)
CPAP during transfer	0.32 (0.10–0.88)	0.72 (0.27–1.83)

Study	Population	Key result
Watson et al. (2013)	758 VLBW infants	The outborn–IVH association attenuated after adjustment: OR 1.14; p=0.56.
Redpath et al. (2020)	781 outborn infants <33 weeks	Severe brain injury was 14.7%; gestation and delivery-room compression/epinephrine, not measured transport factors, were associated.
Morris et al. (2022)	293 matched outborn–inborn pairs	Severe IVH was 17% versus 11% (adjusted OR 1.6, 95% CI 1.1–2.7), while vehicle, distance and team skill were not associated.

For transported preterm infants, IVH tracked early instability—not journey time

THE HOT TAKE

Comments

ADJUSTED ASSOCIATIONS ARE NOT TREATMENT EFFECTS

WHAT THE RIDE DID—AND DID NOT—SHOW

DESIGN PRESSURE POINTS

OLDER COHORTS SHARPEN THE DISTINCTION

Before birth

During transition

During retrieval and early NICU care

PRACTICAL INTERPRETATION