title: Effect of inborn versus outborn delivery on clinical outcomes in ventilated preterm neonates: secondary results from the NEOPAIN trial.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of birth center (inborn versus outborn) on morbidity and mortality for preterm neonates (23 to 32 weeks) using data collected prospectively within a uniform protocol.
  
  
  METHODS
  Secondary analyses of data from the NEurologic Outcomes and Pre-emptive Analgesia In Neonates (NEOPAIN) trial (n=898) were performed to evaluate the effect of inborn versus outborn delivery on neonatal outcomes, including the occurrence of severe intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), chronic lung disease (CLD), and mortality.
  
  
  RESULTS
  Outborn babies were more likely to have severe IVH (p=0.0005); this increased risk persisted after controlling for severity of illness. When adjustments for antenatal steroids were added, the effect of birth center was no longer significant. Neither the occurrences of PVL or CLD nor mortality were significantly different between the inborn and outborn infants.
  
  
  CONCLUSIONS
  Outborn babies are more likely to have severe IVH than inborn babies, perhaps because their mothers are less likely to receive antenatal steroids. Improvements in antenatal steroid administration to high-risk women may substantially reduce neonatal morbidity.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
authors.forename: Kristine G
authors.initials: KG
authors.lastname: Palmer
authors.forename: Shari S
authors.initials: SS
authors.lastname: Kronsberg
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Barton
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Hobbs
authors.forename: Richard W
authors.initials: RW
authors.lastname: Hall
authors.forename: K J S
authors.initials: KJ
authors.lastname: Anand
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000628:therapy*; D008423:Maternal Age; D010360:Patient Transfer; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic