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

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.