Mortality Among Outborn Versus Inborn Neonates: A Retrospective Comparative Study

Background: Neonates born in inappropriately low levels of care outside perinatal centres have high mortality, decline in the neonatal mortality rates after regionalization of perinatal care which emphasised delivery of high risk and preterm infants less than 32 weeks at perinatal centres and establishment of neonatal transport team attending birth when feasible. Aim of the Study: The aim of this study is to find whether outborn neonates (born and transferred to neonatal intensive care unit in the pediatric hospital) versus inborn neonates (born and managed in the same center) are different in mortality risk factors with exploration of the effect of way of transport in the outborn group. Material and Method: A retrospective comparative study between both neonatal intensive care units of Cairo university hospitals where data of all neonates who died over one year from January-December 2007 were collected from patients’ files and analyzed. Result: Mortality among the outborn group 43.7% and among the inborn group 29.59%, the outborn group showed more mean gestational age and body weight than the inborn group (p=0.000) and less duration of survival ( p=0.042). The mean age at presentation of the outborn group was 5.47 ±5.3 which was correlated with development of sepsis, need of inotropic support, mean blood pressure in the gestational age group <30 weeks, 19.6% of the outborn group presented with oxygen support which was correlated with the duration of survival, need of inotropic support and severity of acidosis in gestational age group <30 weeks. Sepsis was statistically significant more in outborn group (p=0.036). Respiratory distress syndrome was a common presentation in the inborn group (p=0.038). Conclusion: In the present study mortality was more among outborn group, they have a more mean gestational age and mean body weight than the inborn group. 80.3% of the outborn group was improperly transported to the neonatal intensive care without oxygen support even in very small gestational age group. Presence of sepsis was more in the outborn group and it was correlated with both age at presentation and duration of survival before death.