Neonatal outcome of inborn and transported very-low-birth-weight infants: relevance of perinatal factors

Objective: To compare the neonatal outcome (survival, intraventricular hemo rrhage and bronchopulmonary dysplasia) of inborn and outborn very-low-birth -weight infants accounting for sociodemographic, obstetric and perinatal va riables. Study design: Ninety-one premature infants with birth weights of 7 50-1250 g delivered between 1990 and 1994 in a hospital providing neonatal intensive care were compared with 76 premature babies delivered in a referr ing hospital. In the statistical analysis, variables with a statistically s ignificant association with the outcome variables and dissimilar distributi ons in the two hospitals were identified and entered together with the hosp ital of birth as explanatory variables in a logistic regression. Results: N o statistically significant differences between the outcome variables of th e two populations examined were observed, whether before or after accountin g for the covariates. The odds ratios (outborns relative to inborns) were 1 .18 for mortality, 1.25 for bronchopulmonary dysplasia and 1.53 for severe intraventricular hemorrhage. In the multivariate analyses, respiratory dist ress syndrome was significantly associated with mortality; both low birth w eight and the presence of respiratory distress syndrome were associated wit h the development of bronchopulmonary dysplasia; the evolvement of severe i ntraventricular hemorrhage was associated with respiratory distress syndrom e, initial low Apgar score, advanced multiparity and delivery at the 28-29t h week compared to the 23rd-27th week. Antenatal steroid administration had a protective effect. Conclusion: Our results concur with the notion that a tertiary center is the optimal location for delivery of the high risk neon ate. Improvement in medical and nursing care prenatally and at delivery and transportation, including frequent administration of antenatal steroids an d earlier administration of surfactant prior to transportation, may minimiz e the disadvantage of delivery in a referring hospital. (C) 1999 Elsevier S cience Ireland Ltd. All rights reserved.