Geographic variations in outcome of very low birth weight infants in Italy

Aim: A number of social and health aspects in Italy show remarkable geographic dishomogeneity. We investigated if this phenomenon involves the outcome of very low birth-weight infants (VLBWI). Methods: This is a multi-centre nation-based survey among all Italian NICUs. The number of VLBWI admitted to each NICU in 2001 by birth-weight classes of 250 g, their inborn/outborn status and survival at discharge were registered through ad hoc questionnaires. The data were analysed for the whole country and for three geographic areas (North, Centre and South). Results: A total of 4679 VLBWI in 125 units were surveyed (0.88% of live births in Italy in 2001). The median number of infants admitted was 34 per NICU (interquartile range 16,52), without significant differences among the three geographic areas. The inborn rate was 80.7% (86.5% in the North, 83.7% in the Centre and 74.6% in the South). The mortality rate was 19.6% (15.6% in the North, 19.3% in the Centre and 23.4% in the South). Adjusted relative risk of death between Southern and Northern regions was 1.48 (95% CI 1.30-1.68), and that between outborn and inborn infants was 1.20 (95% CI 1.04-1.37). Conclusions: The differences in mortality among geographic areas suggest a state of socio-sanitary deprivation in the Southern regions, as well as different models of organisation and quality of perinatal care.