Research Activities, May 2013
High-risk infants have better survival when delivered at hospitals with highlevel neonatal intensive care units
Most women deliver their infants at hospitals that do not have high-level neonatal intensive care units (NICUs). Using a method to account for hospital differences, a new study finds a significantly improved survival when premature babies are delivered in hospitals with high-level NICUs. This advantage is conferred on both extremely and moderately preterm infants.
Researchers reviewed deliveries at hospitals in Pennsylvania, California, and Missouri from 1995 to 2005 (2003 for Missouri). Infants had a gestational age of between 23 and 37 weeks, with birth weights ranging from 400 to 8,000 grams. Delivery at a high-level NICU was studied to determine its effect on in-hospital death and five complications associated with premature birth. Mothers delivering their babies at high-level NICUs tended to have preexisting conditions such as diabetes, premature labor, or another complication of pregnancy. Infants born in these NICUs had a younger gestational age.
Taking hospital differences into account, the researchers found that delivery in these units was associated with lower in-hospital mortality rates. This amounted to 12.6 fewer deaths/1,000 deliveries in Missouri, 7.8 fewer in Pennsylvania, and 2.7 fewer in California. With the exception of infection rates, the three States had similar rates of complications whether infants were delivered at hospitals with high-level NICUs or at other types of delivery hospitals. Higher infection rates were observed in hospitals with high-level NICUs. However, there were lower rates of bronchopulmonary dysplasia at high-level NICUs in Missouri. The study was supported by AHRQ (HS15696).
See "The differential impact of delivery hospital on the outcomes of premature infants," by Scott A. Lorch, M.D., M.S.C.E., Michael Baiocchi, Ph.D., Corinne E. Ahlberg, M.S., and Dylan S. Small, Ph.D., in Pediatrics 130, pp. 270-278, 2012.