Outcome at 2 years of very premature infants cared at the hospital of Cayenne in 1998

Perinatal mortality in French Guyana is twice as high as the national rates. Within a global project rallying all the people working around the birth, a catching up program benefited the neonatality unit of the Cayenne hospital in order to make up for the important lack of modern structures and means. Objectives. - To establish some quality care for the less than 33 weeks preterm infants born in 1998, and to estimate the medical and familial future for these infants after they have reached 2 years of age. Methods. - All less than 33 weeks old infants born alive and admitted at the neonatology unit of the CHC were included in the study. The obstetrical and neonatal data were recorded from the medical files. A survey was conducted through a questionnaire including the familial and medical outcome and was led from december 1999 to july 2001. Results were analysed with Epi-info 6.0 software (CDC, Atlanta, USA). Results. - Eighty-eight infants issue from 78 pregnancies were included. Among them, 29 were transfered in utero and 12 were transfered after birth. The mothers' situations were mainly characterized by precariousness, a poor follow-up of the pregnancy (27% non-declared), a higher morbidity of their newborns. Neonatal results did not differ from national results from Epipage cohort in terms of gestational age (29.9 weeks), weight at birth (1411 g), mortality (90.9 alive when released from the hospital), morbidity, growth at 2. However, 26% were hypotrophic (15% in Epipage cohort) in relation with the 29% pregnancies complicated with hypertension. Four infants were suffering from acquisition retardation due to motor handicaps; 2 infants had severe socio-educative difficulties. The postnatal follow-up was mainly performed by the Mother and Children Health Centers. A third of medical exams were not recorded in the health book, sensory screening exams were not per-formed. The opening of a medicosocial actions center in 2001, will allow a prospective follow-up of this population. Conclusion. - Early neonatal mortality decreased from 10.3 for 1000 births to 4.4 in 1998. This reflects the improvement of the new-born caring possibilities. However, an improvement of mortality rates will not be possible without a better pregnancy follow-up. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tons droits reserves.