Better Neonatal Outcomes Seen for Premature Babies at Hospitals with NICUs

Mortality rates and other complications of premature deliveries are between 100 percent and 300 percent higher at hospitals lacking high-level neonatal intensive care units (NICUs) compared with hospitals with NICUs, an AHRQ-funded study finds. Previous studies of preterm birth outcomes at NICUs showed survival rates between 30 percent and 50 percent, the authors said. The new study is based on more than 1.3 million deliveries of babies with a gestational age of 23 to 37 weeks at hospitals in Pennsylvania, California, and Missouri over a multi-year period. Rather than suggesting that every hospital should build its own high-level NICU, the authors said their findings can assist policymakers in organizing regional and statewide care systems to more efficiently provide care for premature infants within a geographical area. The study, “The Differential Impact of Delivery Hospital on the Outcomes of Premature Infants,” was published online July 9 in Pediatrics. Select to access the abstract on PubMed.®

Pediatrics. 2012 Aug;130(2):270-8. doi: 10.1542/peds.2011-2820. Epub 2012 Jul 9.

The differential impact of delivery hospital on the outcomes of premature infants.

Lorch SA, Baiocchi M, Ahlberg CE, Small DS.

Source

The Children's Hospital of Philadelphia, Center for Outcomes Research, 3535 Market St, Suite 1029, Philadelphia, PA 19104, USA. lorch@email.chop.edu

Abstract

BACKGROUND:

Because greater percentages of women deliver at hospitals without high-level NICUs, there is little information on the effect of delivery hospital on the outcomes of premature infants in the past 2 decades, or how these effects differ across states with different perinatal regionalization systems.

METHODS:

A retrospective population-based cohort study was constructed of all hospital-based deliveries in Pennsylvania and California between 1995 and 2005 and Missouri between 1995 and 2003 with a gestational age between 23 and 37 weeks (N = 1328132). The effect of delivery at a high-level NICU on in-hospital death and 5 complications of premature birth was calculated by using an instrumental variables approach to control for measured and unmeasured differences between hospitals.

RESULTS:

Infants who were delivered at a high-level NICU had significantly fewer in-hospital deaths in Pennsylvania (7.8 fewer deaths/1000 deliveries, 95% confidence interval [CI] 4.1-11.5), California (2.7 fewer deaths/1000 deliveries, 95% CI 0.9-4.5), and Missouri (12.6 fewer deaths/1000 deliveries, 95% CI 2.6-22.6). Deliveries at high-level NICUs had similar rates of most complications, with the exception of lower bronchopulmonary dysplasia rates at Missouri high-level NICUs (9.5 fewer cases/1000 deliveries, 95% CI 0.7-18.4) and higher infection rates at high-level NICUs in Pennsylvania and California. The association between delivery hospital, in-hospital mortality, and complications differed across the 3 states.

CONCLUSIONS:

There is benefit to neonatal outcomes when high-risk infants are delivered at high-level NICUs that is larger than previously reported, although the effects differ between states, which may be attributable to different methods of regionalization.