Background: Regionalization of perinatal care is one of the purposes of the last 'Plan du Gouvernement pour la Périnatalité' (French Government's Perinatal Project). The aims of the study are first to investigate the site of admission of the very low birth weight infants and secondly to analyze postnatal transfer policies.
Population and methods: Neonatal units in France (excluding Ile-de-France area), using exogenous surfactant were asked for their number of intensive care costs (1-5, 6-10, more than 10) and for the yearly rate of admission preterms less than 33 weeks gestational age. They were also classified as academic or not.
Results: One hundred and six out of 129 units participated. Ten units were excluded because they did not use surfactants. Among the 71 non academic units, the number of intensive care cots was less than six in 57/71 (80%) vs 1/25 (4%) in the academic units. There was no relationship between the number of admission and transfer policy. In 29 units with less than six cots, and in 20 of those with 20 admissions or less, transfer occurred exceptionally or never.
Conclusions: The concept of "critical mass", usually recommends to ensure expertise, is not warranted in most French neonatology units. It is worrisome to state that many small units do not transfer any children or do it for a limited number. On the other hand, a majority of the infants transferred post-natally could have drawn benefit from in utero transfer. From these data, it is possible to assume that regionalization of perinatal care is far from achieved in most parts of the French territory.