Outcome of neonatal intensive care: obstetric implications for a regional service

Summary. Data from 634 newborn babies with birthweights ≤2000 g admitted to the South West Thames Regional Neonatal Unit in St George's Hospital since its opening in 1980 were analysed. Only 271 (43%) of the pregnancies were booked there; 200 (32%) of the babies were transferred in utero and 162 (26%) after delivery. Weight-specific neonatal survival rates, calculated after exclusion of lethal abnormalities showed that between 1001 and 1500 g, 79 (96%) of the 82 babies transferred in utero survived in 1981–1984, compared with only 57 (79%) of the 72 postnatal transfers (P<0.02). Under 1000 g, no such differences were found, possibly because paediatricians transferred only the fitter babies in this weight range. The birth of very-low-birthweight babies of short gestation in units unable to provide immediate resuscitation, adequate stabilization and full neonatal intensive care is a major risk factor for increased neonatal mortality. These findings support the role of regional perinatal centres as service units for antenatal transfer and neonatal intensive care, and as teaching centres.