title: 5-year morbidity among very preterm infants in relation to level of hospital care.
abstract: OBJECTIVE
  To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children.
  
  
  METHODS
  A cohort study.
  
  
  METHODS
  Finland.
  
  
  METHODS
  All surviving 5-year-old children born very preterm (gestational age <32 weeks or birth weight ≤1500 g) born in level II or level III hospitals (n = 2168) and full-term (gestational age, 37-42 weeks) children (n = 238 857) born from January 1, 2000, through December 31, 2004.
  
  
  METHODS
  Diagnoses issued after the first discharge home and overrepresented in very preterm compared with full-term children. Diagnoses were analyzed between very preterm children (1) born and treated in level III hospitals (group III), (2) born in level III and transferred to lower-level hospitals (group III/II), and (3) born and treated in level II hospitals (group II).
  
  
  RESULTS
  Group III/II children had an increased incidence of retinal disorders (odds ratio, 2.43 [95% CI, 1.66-3.56]) and asthma (1.41 [1.09-1.81]) but fewer viral infections (0.75 [0.59-0.95]) compared with group III infants. The risks for epilepsy (odds ratio, 2.71 [95% CI, 1.29-5.70]) and hyperkinetic disorders (2.19 [1.13-4.25]) were higher among group II than among group III children. No statistically significant differences between the groups for the 14 other diagnoses were found.
  
  
  CONCLUSIONS
  The increased incidence of retinopathy and asthma among infants transferred from level III to lower-level hospitals calls for analysis of the differences in treatment practices between hospital levels.
authors.affiliation: Department of Pediatrics, Turku University Hospital, 20520 Turku, Finland. liisi.rautava@utu.fi
authors.forename: Liisi
authors.initials: L
authors.lastname: Rautava
authors.forename: Janne
authors.initials: J
authors.lastname: Eskelinen
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.forename: Liisa
authors.initials: L
authors.lastname: Lehtonen
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D015931:Intensive Care, Neonatal; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D012042:Registries; D063127:Secondary Health Care; D062606:Tertiary Care Centers; D063128:Tertiary Health Care