A recent JAMA news release stated that preterm and low birth weight infants need highly specialized care in Level Three hospitals to minimize neonatal (first four weeks after death) and predischarge deaths.
Previous studies make the following statement:
For more than 30 years, guidelines for perinatal [pertaining to the period immediately before and after birth] regionalization have recommended that very low-birth-weight (VLBW) infants be born at highly specialized hospitals, most commonly designated as level III hospitals. Despite these recommendations, some regions continue to have large percentages of VLBW infants born in lower-level hospitals.
Sarah Marie Lasswell, M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues took this previous research and formed a meta-analysis of the relationship between hospital level at birth mortalities in neonatal infants, predischarge deaths and preterm deliveries of 32 weeks or less. The goal was to evaluate the level of care and specialization these infants needed to survive.
The percentages of increased survival amongst the sample of 104,944 infants with VLBW (very low birth weight) proved to be substantial. A 62% increase in deaths transpired between Level Two and Level One facilities compared with Level Three care. A smaller sample of 46,318 infants showed a 60% increase in odds of mortality when treated in a Non-Level Three care center. Finally, infants born with VLBW of less than 1,000 grams (35 oz.) or predischarged had an extremely higher level of mortality when not treated in a Level Three facility. There was an 80% increase in deaths.
Smaller samples of 9,300 and 6,100 infants recorded a 55% and 42% increase in mortality rates in neonatal/predischarge infants respectively when not treated properly at Level Three specialized centers.
Dr. Lasswell and colleagues said:
The results of this review confirm a primary premise on which perinatal regionalization systems are based: high-risk infants have higher mortality rates when born outside hospitals with the most specialized levels of care. Although they represent less than 2 percent of U.S. births, 55 percent of infant deaths occur among VLBW infants. Strengthening perinatal regionalization systems in states with high percentages of VLBW and VPT infants born outside of level III centers could potentially save thousands of infant lives every year.
The authors seek further insight into intervention and prevention moving forward:
Future research should use appropriate risk adjustment and thorough reporting of hospital-level information. Further exploration of the effect of hospital volume, obstetrical level, infants that remain for care at lower-level hospitals after birth, and additional outcome measures such as long-term infant morbidity and fetal and maternal mortality will add to the understanding of this important intervention.
A Meta-analysis
Sarah Marie Lasswell, MPH; Wanda Denise Barfield, MD, MPH; Roger William Rochat, MD; Lillian Blackmon, MD
JAMA. 2010;304(9):992-1000. doi:10.1001/jama.2010.1226
Written by: Sy Kraft, B.A. – Journalism – California State University, Northridge (CSUN)