European Journal of Obstetrics & Gynecology and Reproductive Biology
Outborn status with a medical neonatal transport service and survival without disability at two years: A population-based cohort survey of newborns of less than 33 weeks of gestation
Introduction
Very premature infants are at high risk of mortality and disability. Prenatal events are thought to play an important role in long-term handicap [1], but the specific role of perinatal factors remains controversial. Inborn status was found to have a protective effect on neonatal survival in Ozminkowski's meta-analysis [2]. The lack of regionalization of neonatal care in the Ile de France led to the development of a Medical Neonatal Transport Service, the SMUR (Service Mobile d'Urgence et de Réanimation) at the end of the 1970s. In 1985 a French population-based survey of very premature infants, of 32 weeks gestation or less, was conducted in the Paris metropolitan area [3]. Its purpose was to describe mortality rate and outcome at two years by gestational age (GA). The present study used some of these data to examine whether a very premature infant's inborn status continued to exert a protective effect, despite the improvement in treatment of transferred or outborn infants offered by SMUR. In particular, we evaluated the role this service could play in perinatal management in view of the frequency of outborn status in very premature infants. To do this, we decomposed the various elements of perinatal management and assessed their relationship to survival without disability at the age of two years. Multivariate analysis was restricted to the subgroup of 31–32 weeks gestation to avoid indication bias.
Section snippets
Sample
The data came from the 1985 survey conducted in the Paris region [3]. That study included every public hospital with a maternity unit, every private hospital or clinic with a maternity unit handling at least 1200 births per year, and half of the private hospitals and clinics with fewer than 1200 births per year (randomly sampled). Data were collected for six months in the two first groups of hospitals and for a period of 12 months in the last group, thus achieving a sampling fraction of 1/2.
Study population
Of the 539 births, 57 live births occurred at 27–28 weeks, 100 at 29–30 weeks, and 220 at 31–32 weeks. The results for mortality and disability as related to inborn/outborn status are shown in Table 1. The infant mortality rates for live births at 27–28, 29–30, and 31–32 weeks were, respectively, 52.6%, 28.5% and 14.8%, leading to an overall mortality rate of 24.5% (88/359).
There were 220 live births at 31 or 32 weeks, none with congenital anomalies. Sixteen (7.2%) of these children had been
References (23)
- et al.
Estimation of foetal weight with the use head, body and femur measurements - A prospective study
Am J Obstet Gynecol,
(1985) - et al.
Birthweight specific trends in cerebral palsy
Arch Dis Child
(1990) - et al.
Inborn/outborn status and neonatal survival: a meta-analysis of non randomised studies
Stat Med
(1988) - et al.
Devenir des prématurés de moins de 33 semaines d'âge gestationnel: résultats d'une enquête menée en 1985 dans la région Parisienne
J. Gynecol Obstet Biol Reprod
(1990) - et al.
The impact of confounder selection criteria on effect estimation
Am J Epidemiol.
(1989) Logistic regression in epidemiology Part I
Epidemiol Pub Health.
(1991)Logistic regression in epidemiology Part II
Epidemiol Pub Health.
(1991)- SAS User's guide. Raleigh, NC: SAS Institute Inc,...
- Dixon WJ, editor. BMDP statistical software manual. Berkeley: University of California Press,...
- et al.
Intra uterine growth in lenght and head circumference as estimated from live births at gestational ages from 26 -42 weeks
Pediatrics
(1966)
Evaluation of foetal weight
SOGC J,
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