[Type of birth center and conditions of transfer of neonates under 1500 g or gestational age under 33 weeks].
BACKGROUND
Perinatal care's organization has been widely discussed in France during this last decade. Until now, transfer of high-risk neonates from their birth maternity to a pediatric unit using mobile vehicles led by specialized teams is encouraged in this country.


METHODS
Retrospective analysis of the type of maternities of birth for a population of 717 newborns, weighing less than 1,500 g and/or of gestational age under 33 weeks, extracted from a sample of 84,279 births in 1991.


RESULTS
Only 15.6% of studied births took place in a maternity including a special intensive care pediatric unit (international level 3); 58.7% of those newborns where transferred outborn. There was a significant difference between the immediate access of newborns to a level 3 pediatric unit according to the location-of birth: significantly fewer newborns were directly transferred to a level 3 unit when born in a facility that included a level 2 pediatric unit, compared with those born in facilities that included a level 1 or 3 pediatric unit.


CONCLUSIONS
Strong efforts should be made to identify mothers at high risk of giving birth to extremely prematured babies or babies with a very low birthweight so that births could take place in maternities properly equipped for their care. Perinatal care's organization should be built on a hierarchical network of maternities and pediatric services related to the risk of the population. Accreditation of maternities and pediatric services could help moving towards this kind of organization.
Chale
J J
JJ
Département d'information médicale, CHU Hôtel-Dieu-Saint-Jacques, Toulouse, France.
Vial
M
M
Brodin
M
M
Colladon
B
B
Lacroix
A
A
Nisand
I
I
Palot
M
M
Papiernik
E
E
Souteyrand
P
P
Naiditch
M
M
D015982:Bias; D016550:Birthing Centers / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014164:Transfer Agreement / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data