Abstract
BACKGROUND: Studies have reported a higher risk of adverse neonatal outcomes in outborn infants compared to those born within a tertiary center; however data on neurodevelopmental outcomes are limited. OBJECTIVES: To compare mortality and neurodevelopmental outcomes of preterm infants of <29 weeks gestation born outside a tertiary care center with those born at tertiary centers. DESIGN/METHODS: Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants of <29 weeks gestation and admitted to a tertiary NICU between April 2009 and September 2011 who underwent a standardized assessment at 18-21 months age, including history, physical and neurological exams, and Bayley-III assessment. Outcomes of death or significant neurodevelopmental impairment (sNDI), death or any neurodevelopmental impairment (NDI) and individual components of assessment were compared between outborn and inborn infants after adjustment for confounders (GA, SGA, multiples, antenatal steroids, SNAPII score and mode of delivery). RESULTS: Of a total of 2951 infants, 2478 (84%) were inborn and 473 (16%) were outborn. Mean BW (897g vs 940g), receipt of antenatal steroids (94% vs 54%), SGA (9.4% vs 5.3%), caregiver college education (55% vs 44%), differed between inborn and outborn respectively. The median SNAP II score and Apgar at 5 min were higher in inborn whereas TRIPS score on admission was higher for outborn. Adjusted OR for neurodevelopmental outcomes are reported in Table. CONCLUSION: Mortality or adverse neurodevelopmental outcomes are significantly higher in preterm infants <29 weeks GA born outside of a tertiary care center.