Article Text

TYPE OF HOSPITAL OF ADMISSION AND SHORT-TERM OUTCOME FOR OUTBORN VERY LOW BIRTH WEIGHT OR VERY LOW GESTATIONAL AGE INFANTS: AN ITALIAN POPULATION-BASED STUDY
  1. S M Orlando1,
  2. F Franco2,
  3. D DiLallo2,
  4. C Corchia1
  1. 1Department of Medical and Surgical Neonatology, Bambino Gesú Children’s Hospital, Rome, Italy
  2. 2Agency for Public Health, Lazio Region, Rome, Italy

Abstract

Objective Outcome for outborn preterm infants can be influenced by the type of hospital of admission. The aim of this study is to examine whether the outcome for very preterm or very low birth weight (VLBW) outborn infants is different if they are admitted to tertiary perinatal centres (TPC) or to a freestanding paediatric hospital (FPH) in a regional setting in Italy.

Methods All infants less than 32 weeks gestational age or less than 1500 g birth weight born in 2003–4 in the Lazio region, Italy, and admitted to hospitals different from those of birth before 48 h of life were studied. The relationship of hospital type of admission with inhospital mortality and other outcomes was performed by univariate and multivariate analysis (Cox model), adjusting for CRIB score.

Results The infants studied were 316, 201 admitted to 11 TPC and 115 to one FPH. The crude overall mortality rate and the frequency of sequelae at discharge were respectively 24.5% and 15.1%, with no statistically significant differences between the two groups of hospitals. Adjusted hazard ratio of mortality for FPH versus TPC was 1.16 (95% CI 0.77 to 1.74). The frequencies of patent ductus arteriosus, necrotising enterocolitis and sepsis were significantly higher in the FPH compared with TPC (65.7% vs 51.1%; 11.3% vs 1.5%; and 27.8% vs 16.1%).

Conclusion In our regional setting the short-term outcome for very preterm or VLBW outborn infants is not influenced by the type of hospital of admission. The higher frequency of patent ductus arteriosus, necrotising enterocolitis and sepsis in the FPH could be related to different diagnostic criteria and/or to a higher degree of invasiveness.

Groenendaal et al Results

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