The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants

Objective: To determine the incidence of grade III or IV intraventricular h emorrhage in very low birth weight (VLBW) infants born at level I hospitals and transported to one tertiary center compared with those delivered at th e same level III facility. Methods: We evaluated all newborns admitted to a large tertiary neonatal in tensive care unit from June 1, 1992, through December 31, 1995. All live bo rn infants with birth weights of 500-1200 g and at least 24 weeks' gestatio n were included. Neonatal transports within 24 hours of delivery from 11 le vel I facilities were compared with those delivered at the same level III c enter with respect to grade III and IV intraventricular hemorrhage. Various antenatal and neonatal data were collected. Results: Thirty-seven newborns (11%) experienced grade III or IV intraventr icular hemorrhages among 329 who met study criteria. There were 27 cases (9 %) in the 285 inborn neonates compared with 10 of 44 outborn cases (23%) (P < .02, 95% confidence interval 0.15, 0.87). The mean gestational age of th e neonates with grade III or IV intraventricular hemorrhages was significan tly lower in the inborn group, which further emphasizes the finding. No oth er study factors explained the difference. Conclusion: We found a higher risk for grade III or IV intraventricular hem orrhage developing in VLBW infants born at level I hospitals and transporte d to the tertiary care center compared with those born at the level III fac ility. This data should be considered when analyzing the potential effects of perinatal deregionalization. (Obstet Gynecol 2000;95:291-5. (C) 2000 by The American College of Obstetricians and Gynecologists.).