Archives of Disease in Childhood - Fetal and Neonatal Edition 2006;91:F251-F256
ORIGINAL ARTICLE
Does rural or urban residence make a difference to neonatal outcome in premature birth? A regional study in Australia
1 Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
2 School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW
3 Neonatal Intensive Care Units Data Collection, NSW Centre for Perinatal Health Services Research, NSW Pregnancy and Newborn Services Network, Sydney
Correspondence to:
Correspondence to:
Dr Lui
Department of Newborn Care, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, 2031 NSW, Australia; k.lui{at}unsw.edu.au
Background: Patients living in rural areas may be at a disadvantage in accessing tertiary health care.
Aim: To test the hypothesis that very premature infants born to mothers residing in rural areas have poorer outcomes than those residing in urban areas in the state of New South Wales (NSW) and the Australian Capital Territory (ACT) despite a coordinated referral and transport system.
Methods: "Rural" or "urban" status was based on the location of maternal residence. Perinatal characteristics, major morbidity and case mix adjusted mortality were compared between 1879 rural and 6775 urban infants <32 weeks gestational age, born in 1992–2002 and admitted to all 10 neonatal intensive care units in NSW and ACT.
Results: Rural mothers were more likely to be teenaged, indigenous, and to have had a previous premature birth, prolonged ruptured membrane, and antenatal corticosteroid. Urban mothers were more likely to have had assisted conception and a caesarean section. More urban (93% v 83%) infants were born in a tertiary obstetric hospital. Infants of rural residence had a higher mortality (adjusted odds ratio (OR) 1.26, 95% confidence interval (CI) 1.07 to 1.48, p = 0.005). This trend was consistently seen in all subgroups and significantly for the tertiary hospital born population and the 30–31 weeks gestation subgroup. Regional birth data in this gestational age range also showed a higher stillbirth rate among rural infants (OR 1.20, 95% CI 1.09 to 1.32, p<0.001).
Conclusions: Premature births from rural mothers have a higher risk of stillbirth and mortality in neonatal intensive care than urban infants.
Abbreviations: ACT, the Australian Capital Territory; CI, confidence interval; NETS, neonatal and paediatric emergency transport service; NICU, neonatal intensive care unit; NSW, New South Wales; OR, odds ratio
Keywords: premature infants; rural; urban; perinatal services; outcome
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
- Full Text
- Full Text (PDF)
- Correction
- Correction (v91,pF390)
-
All Versions of this Article:
adc.2005.090670v1
91/4/F251 most recent - Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in ADC Online
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
