REGIONALIZATION OF NEONATAL CARE IN FRANC E (EXCLUSIVE OF PARIS) - ANAPPROACH THROUGH AN ANALYSIS OF TRANSFER POLICIES OF VERY-LOW-BIRTH-WEIGHT INFANTS

Background. - Regionalization of perinatal care is one of the purposes of the last 'Plan du Gouvernement pour la Perinatalite' (French Gover nment's Perinatal Project). The aims of the study are first to investi gate the site of admission of the very low birth weight infants and se condly to analyze postnatal transfer policies. Population and methods. - Neonatal units in France (excluding the Ile-de-France area), using exogenous surfactant were asked for their number of intensive care cot s (1-5, 6-10, more than 10) and for the yearly rate of admission prete rms less than 33 weeks gestational age. They were also classified as a cademic or not. Results. - One hundred and six out of 129 units partic ipated. Ten units were excluded because they did not use surfactants. Among the 71 non academic units, the number of intensive care cots was less than six in 57/71 (80%) vs 1/25 (4%) in the academic units. Ther e was no relationship between the number of admissions and transfer po licy. In 29 units with less than six cots, and in 20 of those with 20 admissions or less, transfer occurred exceptionally or never. Conclusi ons. - The concept of ''critical mass'', usually recommended to ensure expertise, is not warranted in most French neonatology units. It is w orrysome to state that many small units do not transfer any children o r do it for a limited number. On the other hand, a majority of the inf ants transferred post-natally could have drawn benefit from in utero t ransfer. From these data, it is possible to assume that regionalizatio n of perinatal care is far from achieved in most parts of the French t erritory.