OUTBORN STATUS WITH A MEDICAL NEONATAL TRANSPORT SERVICE AND SURVIVALWITHOUT DISABILITY AT 2 YEARS - A POPULATION-BASED COHORT SURVEY OF NEWBORNS OF LESS-THAN 33 WEEKS OF GESTATION
P. Truffert et al., OUTBORN STATUS WITH A MEDICAL NEONATAL TRANSPORT SERVICE AND SURVIVALWITHOUT DISABILITY AT 2 YEARS - A POPULATION-BASED COHORT SURVEY OF NEWBORNS OF LESS-THAN 33 WEEKS OF GESTATION, European journal of obstetrics, gynecology, and reproductive biology, 79(1), 1998, pp. 13-18
Objective: Prenatal events are thought to play an important role in lo
ng-term handicap, bur the specific role of perinatal factors remains c
ontroversial. Our study, conducted in the context of this debate, aime
d to break down the various components of perinatal management and to
assess the relationship between these components and survival without
disability at the age of two years. Study design: A prospective geogra
phically-defined study was conducted in 1985 in the Paris metropolitan
area. It covered 53430 births (stillbirths and live births), includin
g 539 that occurred between 25 and 32 weeks gestation. The relationshi
p between perinatal management and survival without disability was stu
died by a multivariate analysis (logistic regression). The analysis wa
s restricted to a group of 202 infants born at 31 or 32 week's gestati
on, to avoid indication bias. Results: An inborn status (delivery in a
tertiary care facility) exerted a protective effect on survival witho
ut disability at the age of two years (Adjusted Odds Ratio (OR) = 7.51
[1.51; 37.4]), even though the area we studied possessed an excellent
Medical Neonatal Transport Service. Multiple pregnancies also seemed
to have a protective effect (Adjusted OR = 2.45 [0.96; 6.27]). No stat
istically significant association was seen between survival without di
sability at two years and the presence of a hospital staff paediatrici
an in the delivery room. Conclusion: These results lead us to consider
what the concept of inborn/outborn represents in the perinatal manage
ment of infants at high risk. (C) 1998 Elsevier Science Ireland Ltd.