A previous report from Canadian Neonatal Network (CNN) revealed that even after adjustments of perinatal risks and admission illness severity, inborn infants had better outcomes compared to out-born infants. It was speculated that lack of availability of specialist support, staffing, expertise and equipment might be related to the poor outcomes in outborn infants. The objective of this study was to examine whether admission hospital type was associated with differences in mortality and morbidity among preterm infants who were born outside the perinatal centres, after adjustment of perinatal risks and admission illness severity (using the Score of Neonatal Acute Physiology, version II). Data was obtained from the Canadian Neonatal Network database. Multiple regression analyses were used to compare the risk-adjusted outcome of 605 outborn singleton infants born at < 32 weeks gestation, admitted to either 13 perinatal centres or 4 free standing pediatric hospitals in Canada during 1996–1997. There was no difference in the gestational age, apgar score, delivery type, prenatal care or SNAP II score between infants admitted to both types of hospitals. Maternal hypertension and administration of complete course of prenatal corticosteroid were more common among infants admitted to free standing pediatric hospitals. Outborn infants admitted to free standing pediatric hospitals were at higher risk of death (adjusted odds ratio [OR] 2.25, 95% confidence interval [CI] 1.20, 4.20), nosocomial infection (adjusted OR 2.48, 95% CI 1.64, 3.73) and oxygen dependency at 28 days of age (adjusted OR 1.77, 95% CI 1.14, 2.75); and at lower risk for developing PDA (adjusted OR 0.46, 95% CI 0.30, 0.69) and lower risk of CPAP dependency at 28 days (adjusted OR 0.66, 95% CI 0.47, 0.93); even after adjustment of perinatal risks and admission illness severity. After adjustment for perinatal risks and admission illness severity, outborn infants had better outcomes if they were admitted to perinatal centres compared to free standing pediatric hospitals. Our results indicate that if in-utero maternal transfers are not possible due to reasons beyond control, efforts should be made to transfer preterm infants to perinatal centres.