Risk factors for neonatal transfers from the Sapopemba free-standing birth centre to a hospital in São Paulo, Brazil

Objectiveto identify risk factors associated with neonatal transfers from a free-standing birth centre to a hospital.Designepidemiological case–control study.Settingmidwifery-led free-standing birth centre in São Paulo, Brazil.Participants96 newborns were selected from 2840 births between September 1998 and August 2005. Cases were defined as all newborns transferred from the birth centre to a hospital (n=32), and controls were defined as newborns delivered at the same birth centre, during the same time period, and who had not been transferred to a hospital (n=64).Measurements and findingsdata were collected from medical records available at the birth centre. Univariate and multivariate analyses were performed using logistic regression. The multivariate analysis included outcomes with p<0.25, specifically: smoking during pregnancy, prenatal care appointments, labour complications, weight in relation to gestational age, and one-minute Apgar score. Of the foregoing outcomes, those that remained in the full regression model as a risk factor associated with neonatal transfer were: smoking during pregnancy [p=0.009, odds ratio (OR)=4.1, 95% confidence interval (CI) 1.03–16.33], labour complications (p<0.001, OR=5.5, 95% CI 1.06–28.26) and one-minute Apgar score ⩽7 (p<0.001, OR=7.8, 95% CI 1.62–37.03).Key conclusions and implications for practicesmoking during pregnancy, labour complications and one-minute Apgar score ⩽7 were confirmed as risk factors for neonatal transfer from the birth centre to a hospital. The identified risk factors can help to improve institutional protocols and formulate hypotheses for other studies.