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.
In a study presented at the European Emergency Medicine Congress recently, 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 3