Background: Perinatal care's organization has been widely discussed in France during this last decade. Until now, transfer of high-risk neonates from their birth maternity to a pediatric unit using mobile vehicles led by specialized teams is encouraged in this country.
Population and methods: Retrospective analysis of the type of maternities of birth for a population of 717 newborns, weighing less than 1,500 g and/or of gestational age under 33 weeks, extracted from a sample of 84,279 births in 1991.
Results: Only 15.6% of studied births took place in a maternity including a special intensive care pediatric unit (international level 3); 58.7% of those newborns where transferred outborn. There was a significant difference between the immediate access of newborns to a level 3 pediatric unit according to the location-of birth: significantly fewer newborns were directly transferred to a level 3 unit when born in a facility that included a level 2 pediatric unit, compared with those born in facilities that included a level 1 or 3 pediatric unit.
Conclusion: Strong efforts should be made to identify mothers at high risk of giving birth to extremely prematured babies or babies with a very low birthweight so that births could take place in maternities properly equipped for their care. Perinatal care's organization should be built on a hierarchical network of maternities and pediatric services related to the risk of the population. Accreditation of maternities and pediatric services could help moving towards this kind of organization.