Vienna, Austria: The first detailed analysis of unplanned births that occurred outside the hospital setting in Austria has shown that, although such deliveries are rare, they pose challenges for emergency teams that attend, especially if babies are born prematurely [1].
In a study presented at the European Emergency Medicine Congress today (Monday), the researchers found that between 2017 and 2024 there were 173 unplanned, out-of-hospital births in the Styria region of Austria, of which 16 (9%) were premature (less than 37 weeks' gestation). The most premature was born at 26 weeks' gestation, weighing 845g, and four babies (25%) died around the time of birth.
Now, the team plan to identify regional differences in the rest of Austria, evaluating the preparedness of emergency teams, and assessing outcomes for both mothers and newborns.
Ms Helena Leonhartsberger, a medical student and research team member in the neonatology department at the Medical University of Graz, Austria, who also volunteers as a paramedic with the Austrian Red Cross, told the congress: "Our study is the first to document the frequency of out-of-hospital, unplanned, premature deliveries and the associated complications. We concluded that standardised emergency protocols and early involvement of specialised neonatal transport teams are crucial for improving outcomes.
"Most emergency physicians are not specialised in paediatrics or, more specifically, in neonatology. Although these scenarios are rare, emergency teams must be adequately trained and prepared to handle them. Furthermore, appropriate equipment for treating newborns, particularly premature or critically ill neonates, should be available on all emergency vehicles.
"We also plan to use these findings to improve training for emergency personnel and to recommend what neonatal emergency equipment should be made available and standardised on all Austrian emergency vehicles, ensuring consistent care nationwide."
Ms Leonhartsberger decided to research this topic after she attended an out-of-hospital birth as a paramedic during her first year of training.
"I was unprepared for the situation, but fortunately, everything went well," she said. "This led me to study pre-hospital deliveries of premature infants, aiming to explore how emergency teams can be better prepared for such high-risk situations and improve outcomes for these vulnerable patients."
The study, which was led by Professor Bernhard Schwaberger, deputy head of the clinical department of neonatology at the Medical University of Graz, found that the median age of babies born prematurely out of hospital was 35 weeks' gestation, with a median birth weight of 2390g.
Among the four babies that died, no resuscitation was attempted in two. One premature baby underwent successful pre-hospital resuscitation and intubation. Of the 12 surviving preterm infants, one required initial bag-mask ventilation and subsequent nasotracheal intubation by a neonatal intensive care team, and another received oxygen via face mask. Ten babies were able to breathe spontaneously.
The researchers found that the temperatures of the babies were recorded in only six of the 13 babies that were admitted to hospital, and the median temperature was 34.8°C; the lowest recorded temperature was 31.5°C.
Ms Leonhartsberger said: "Admission temperature is a key prognostic factor, yet this was not documented for all the babies, and when it was, the babies were often found to be hypothermic.
"Our findings underscore the need for national preparedness, not only through standardised protocols but also through ongoing training and appropriate equipment on all emergency vehicles. They also highlight the importance of public awareness, reinforcing that, while planned home births may be safe under ideal conditions, complications can arise quickly and unpredictably. The research supports the broader goal of improving maternal and neonatal outcomes by ensuring that every birth, regardless of location, receives the highest standard of emergency care."
A strength of the study is the detailed analysis of premature births outside of hospitals. The main limitation is the small number of cases and the fact that it focuses on one region of Austria so the finding may not reflect the situation in other areas. This is why the researchers now plan to analyse data in other regions.
Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: "Premature deliveries always require careful medical supervision in hospital and will be performed by a highly trained and diverse team of experienced professionals to reduce any serious risk to both mother and baby. When these premature births take place out of the hospital setting in the unprepared environment of a household or an ambulance with a smaller team they present an even more significant challenge. Even though they are rare, they require preparation and the training that is part of the so-called HALO procedures: High-Acuity Low Occurrence.
"Helena Leonhartsberger's study shows, for the first time, the incidence of such births in one region in Austria, and how there were variations in how these births were managed. For instance, temperature management is a very important factor for the efficacy of further treatments. In this highly stressful setting, unfortunately only six out of the 13 babies admitted to hospital had their temperatures recorded, despite the importance of this intervention. It is crucial to identify the incidence and management of premature, unplanned, out-of-hospital deliveries, not just in other areas of Austria but also in other countries. This will enable planning to ensure that all emergency medical services adhere to agreed protocols, and that they have swift access to specialist neonatal equipment for treating and transporting premature babies to hospital."
