title: Effect of place of birth and transport on morbidity and mortality of preterm newborns.
abstract: OBJECTIVE
  To evaluate the effect of place of birth and transport on morbidity and mortality of preterm newborns in the southern region of Brazil.
  
  
  METHODS
  This cohort study included preterm newborns transported to a reference intensive care unit (transport group = 61) and followed up until discharge. Data about care in hospital of origin and transport were obtained at admission. This group was compared with infants born in the maternity ward of the reference hospital paired according to gestational age (control group = 123). Primary outcome was death, and secondary outcomes were changes in blood glucose, temperature and oxygen saturation at admission and the incidence of necrotizing enterocolitis, bronchopulmonary dysplasia and sepsis. Relative risk (RR) was used to evaluate the association between variables and outcome. The level of significance was set at α = 5% and β = 90%.
  
  
  RESULTS
  Mean travel distance was 91 km. Mean gestational age was 34 weeks. Of the neonates in the transport group, 23% (n = 14) did not receive pediatric care in the delivery room. During transportation, 33% of newborns were accompanied by a pediatrician, and the equipment available was: incubator (57%), infusion pump (13%), oximeter (49%) and device for blood glucose test (21%). The transport group had a greater incidence of hyperglycemia (RR = 3.2; 2.3-4.4), hypoglycemia (RR = 2.4; 1.4-4.0), hyperthermia (RR = 2.5; 1.6-3.9), and hypoxemia (RR = 2.2; 1.6-3.0). The percentage of deaths was 18% in the transport group and 8.9% in the control group (RR = 2.0; 1.0-2.6).
  
  
  CONCLUSIONS
  This study revealed deficiencies in neonatal care and transport. Perinatal care and transport should be better organized in the northeastern region of Rio Grande do Sul, Brazil.
authors.affiliation: Universidade de Caxias do Sul (UCS), Caxias do Sul, RS, Brazil. bfaraujo@terra.com.br
authors.forename: Breno F
authors.initials: BF
authors.lastname: Araújo
authors.forename: Helen
authors.initials: H
authors.lastname: Zatti
authors.forename: Petrônio F
authors.initials: PF
authors.lastname: Oliveira Filho
authors.forename: Márcio B
authors.initials: MB
authors.lastname: Coelho
authors.forename: Fabriola B
authors.initials: FB
authors.lastname: Olmi
authors.forename: Tatiana B
authors.initials: TB
authors.lastname: Guaresi
authors.forename: José M
authors.initials: JM
authors.lastname: Madi
mesh_terms: D000552:Ambulances / Q000600:supply & distribution*; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D009725:Nurseries, Hospital / Q000592:standards* / Q000600:supply & distribution; D011181:Postnatal Care / Q000592:standards*; D012307:Risk Factors; D014187:Transportation of Patients / Q000592:standards* / Q000706:statistics & numerical data