Ausr. zyxwvutsrqponmlk NZ J Ohsrer Gynaecol zyxwvutsrqpo IW7; zyxwvutsrqpon 37: 3: 253 zyxwvutsrq THE AUSTRALIAN zyxwvut & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY zy Vol. 37 - NO. 3 August, 1997 Changing Outcome for Infmts of Birth-weight 500-999g Born Outside LRvel3 Centres in zy victoria The Victorian Infant Collaborative Study Group* The Royal WomenS Hospital,' the Mercy Hospital zyxwv for Wornen? Monash Medical Cent& the Ro-val Childmn s Hospital,' the Newborn Emergency Transport ServiceS zyx und the Victorian Perinutal Data Collection Unit: Melbourne, Australia Summryr The aim of this study of extremely low birth-weight (ELBW, birth-weight 500-999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979-80, 1985-87, and 1991-92, in the proportions who were born outside level 3 pennatal centres (outborn), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979-80, to 23.0% (129 of 560) in 1985-87, and to 15.6% (67 of 429) in 1991 -92. Between 1979-80 and 1985-87, the proportions who were outborn fell predominantly in those of birth-weight from 800-999 g, whereas between 1985- 87 and 1991-92 the proportions who were outborn fell predominantly in those of birth-weight 500-799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in the 3 eras, at 49.1%, 38.0% and 41.2%. respectively. The survival rates for outborn infants were lower in each era than for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level-3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 199-92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between the first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high-risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres. * Participants: Convener, Lex W. Doyle, paediatrician'. Collaborators (in alphabetical order); Ellen Bowman, paediatrician,' ' Catherine Cdtanan, research nurse', Elizabeth Carse, paediatrician', Margaret P. Charlton, psychologist', John Drew, paediatrician', Geoffrey Ford, paediatrician', Simon Fraser. paediatrician, Jane Halliday. epidemiologist", Marie Hayes, research nurse', Elaine Kelly, psychologist,' Peter McDougall, paediatrician', Anne Rickards, psychologist'. Andrew Watkins, paediatrician', Heather Woods. research nurse', Victor Yu, paediatrician'. Address for correspondence: Associate Professor L.W. Doyle, Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia, 3052.