BIRTH LOCATION AND CONDITIONS OF TRANSFER FOR NEONATES WEIGHING LESS-THAN 1,500 G OR OF GESTATIONAL-AGE UNDER 33 WEEKS

Background. - Perinatal care's organization has been widely discussed in France during this last decade. Until now, transfer a high-risk neo nates from their birth maternity to a pediatric unit using mobil vehic les led by specialized teams is encouraged in this country. Population and methods. - Retrospective analysis of the type of maternities of b irth for a population of 717 newborns, weighing less than 1,500 g and/ or of gestational age under 33 weeks, extracted from a sample of 84,27 9 births in 1991. Results. - Only 15.6% of studied births rook place i n a maternity including a special intensive cave pediatric unit (inter national level 3); 58.7% of those newborns where transferred outborn. There was a significant difference between the immediate access of new borns to a level 3 pediatric unit according to the location of birth: significantly fewer newborns were directly transferred to a level 3 un it when born in a facility that included a level 2 pediatric unit, com pared with those born in facilities that included a level or 3 pediatr ic unit. Conclusion. - Strong efforts should be made to identify mothe rs at high risk of giving birth to extremely prematured babies or babi es with a very low birthweight so that births could take place in mate rnities properly equiped for their care. Perinatal care's organization should be built on a hierarchical network of maternities and pediatri c sen;ices related to the risk of the population. Accreditation of mat ernities and pediatric services could help moving towards this kind of organization.