Delayed Admission to NICU Is Associated With In‐Hospital Mortality After Perinatal Asphyxia: A Retrospective Single‐Centre Study

AIM: To investigate whether outborn birth, defined as birth in a maternity unit without permanent in-house paediatric coverage and the need for postnatal transfer, is associated with in-hospital mortality in infants with perinatal asphyxia treated with therapeutic hypothermia, compared to birth at a tertiary cooling centre. METHODS: Retrospective single-centre cohort study of infants ≥ 36 weeks of gestation with perinatal asphyxia receiving therapeutic hypothermia at a German tertiary centre serving nine maternity units, between 1 January 2012 and 31 January 2025. RESULTS: Of 5541 infants admitted, 131 (2.4%) were treated for perinatal asphyxia, of whom 82/131 (62.6%) received therapeutic hypothermia with an in-hospital mortality of 21/82 (25.6%). Mortality was 2/25 (8.0%) in inborn and 19/57 (33.3%) in outborn infants (odds ratio 5.8, 95% confidence interval 1.3-26.4). Among outborn infants, mortality was higher after birth in rural than in urban units (16/33 (48.5%) versus 3/24 (12.5%); odds ratio 6.6, 95% confidence interval 1.6-23.4). Non-survivors waited longer for the arrival of the neonatal team (mean 38 vs. 28 min). Mortality was comparable between inborn infants and outborn infants born in urban units. CONCLUSION: Outborn birth, particularly in rural maternity units with longer times to specialised neonatal care, was associated with in-hospital mortality.