BIRTH SITE OF BABIES OF LESS-THAN 33 WEEK S AND RISK PER PARTUM AND NEONATAL DEATH BY LEVEL OF PERINATAL-CARE

The present study in a case-control study in a population based collec tion of data of all births from 22 to 32 weeks in all maternities of t he Seine-Saint-Denis district for three years, 999 on 67 819 total bir ths. The study describes the site of births by level of perinatal care (level 3 maternity associated with a neonatal intensive care unit, le vel 2 with a neonatal pediatric ward without intensive care, and level 1 without any of these pediatric services. The proportion of births a t a level 3 maternity is 6.3 % for all births, and 12.9 % for live bir th of less than 33 weeks. The study describes the transferts of the li ve babies to a neonatal intensive care by external transferts from lev el 1 and level 2 units or internal transferts in level 2 and 3 units. All babies are transfered. The study describes the per partum and neon atal deaths up to 25 days by week of gestation duration and site of bi rth. The study uses the comparison between the deaths during delivery (from 28 to 32 weeks) and in the first 28 days compared to controls, u sing a regression analysis method. The risk of per partum and neonatal death is OR = 8,08 [1,03-76,40] when site of birth 2 is compared to 3 and OR = 11,78 [1,33-103,77] when site of birth 1 is compared to 3. T he study shows that the french obstetricians and pediatricians have no t accepted the international consensus proposing that births of less t han 33 weeks should take place in level 3 perinatal units, goal which is reached for 80 % of those births, with less neonatal deaths and dev elopmental handicaps.