This national study addresses the effect of the available level of technology at the hospital of delivery on preterm deliveries, survival and subsequent health status of children at age three. The national study incorporates oversampling of very low birth weight infants as well as fetal and infant deaths. Survival time of deliveries are analyzed by age at death for infants or gestational age for a fetal death, symptoms at presentation, use of interventions, and level of technological support available at the delivery hospital while accounting for gestational age and other risk factors. Health status differences at age three are from measures included in a 1991 longitudinal follow-up of a nationally representative survey of all children born in 1988 performed by the National Center for Health Statistics (NCHS). The health outcome measures include development, overall health status, chronic conditions, recent illness, use of apnea monitors and ear tubes, vitamin/mineral use, and use of home treatments. Hospital and physician records from the perinatal and pediatric period are included in the analysis. Studies on pregnancies concluded that in 1988, between 30-45% of high risk women delivered outside of hospitals with the highest levels of care at the time. Classification as a live birth rather than a fetal death in pregnancies delivered between 23- 27 weeks gestational age was more likely if women lived in counties with high technology hospitals. Also, reporting of gestational age at 23-27 weeks is inaccurate on birth certificates in about ten percent of cases when compared to multiple information sources from hospital records. - high risk pregnancies, perinatal outcomes, gestational age
