Evaluate the risk of severe intraventricular haemorrhage (IVH), in the first week of life, in preterm infants undergoing early inter-hospital transport. Design Retrospective cohort study SettingTertiary neonatal centres of the Trent Perinatal Network in the UK. PatientsPreterm infants <32 weeks gestation, who were either born within and remained at the tertiary neonatal centre (inborn), or were transferred (transported) between centres in the first 72 hours of life. MethodsMultivariable logistic regression models adjusting for key confounders were used to calculate odds ratios (OR) for IVH with 95% confidence intervals (CI) for comparison of inborn and transported infants. Interventions None MeasurementsCranial ultrasound findings on day 7 of life. Secondary analyses were performed for antenatal steroid course and gestational age subgroups. Main ResultsA total of 1047 preterm infants were included in the main analysis. Transported infants (n=391) had a significantly higher risk of severe (grade III/IV) IVH compared with inborns (n=656) (9.7% vs 5.8%, aOR 1.69, 95%CI 1.04-2.76), especially for infants born at <28 weeks gestation (aOR 1.83, 95%CI 1.03-3.21). Transported infants were less likely to receive a full antenatal steroid course (47.8% vs 64.3%, p<0.001). A full antenatal steroid course significantly decreased the risk of severe IVH irrespective of transport status (OR 0.33, 95%CI 0.2-0.55). However, transported infants <28 weeks gestation remained significantly more likely to develop a severe IVH despite a full antenatal steroid course (aOR 2.84, 95%CI 1.08-7.47). ConclusionPreterm infants transported in the first 72 hours of life have an increased risk of early-life severe IVH even when maternal antenatal steroids are given. The additional burden of postnatal transport could be an important component in the pathway to severe IVH. As timely in-utero transfer isn't always possible, we need to focus research on improving the transport pathway to reduce this additional risk.