DIFFERENCES IN MORBIDITY AND MORTALITY ACCORDING TO TYPE OF REFERRAL OF VERY-LOW-BIRTH-WEIGHT INFANTS

Maternal and social risk, prenatal and obstetric care, resuscitation a nd neonatal care in very-low-birthweight infants (VLBW) may vary with the type of referral. In 453 VLBW's (< 1500 g) admitted to our neonata l intensive care unit 1987 1992, we classified transport type as: A: N o transport (n = 240), B: Maternal transport (n = 88), C: Infant trans port (n = 125). Stepwise multiple discriminant function was determined for the identified factors. The risk of mortality was investigated by logistic regression analysis. In group A, mean maternal age was highe r and mothers' social status lower than in groups B and C. In group B, infants were considerably smaller and less mature, but when adjusted for gestational age, suffered less frequently from PDS, obviously due to more frequent induction of lung maturation. In group C, less than h alf of the infants were resuscitated by a neonatologist. Infants of th is group were frequently hypothermic at admission and required prolong ed artificial ventilation more frequently. Total VLBW survival average d 77%, increasing from 69 to 88% within the study period. Total rate o f severe intraventricular hemorrhage was 4.8% in surviving infants. VL BW infants with different forms of referral differ in their inherent r isk. After maternal transport they have less morbidity despite a highe r grade of immaturity. Regionalization of perinatal care for these inf ants remains the greatest potential for further reduction in infant mo rtality.