Premature babies born in high-level neonatal intensive care units (NICUs) have a better chance of survival than those born in hospitals without such facilities. A new study, published in the journal Pediatrics, has shown that this benefit is significantly larger than research had previously reported.
Experts already knew that an extremely premature baby born in a hi-tech, high-volume hospital unit has a much better chance of survival. This study, the largest to date, showed that survival benefits were even greater than previously thought. Over a 10-year span, pediatric researchers examined over 1.3 million premature births. They discovered that the survival benefits applied not only to extremely preterm babies, but also to moderately preterm newborns.
A retrospective study was performed of all hospital-based-deliveries of infants with a gestational age of between 23 and 37 weeks in Missouri, California, and Pennsylvania. Researchers examined a total of 1,328,000 births, focusing on preterm deliveries in high-level NICUs compared to preterm deliveries at all other hospitals.
Scott A. Lorch, M.D., research leader and neonatologist at The Children’s Hospital of Philadelphia, said:
“Prior studies from the early 1990s found increased survival rates of 30 to 50 percent among preterm infants delivered at high-level NICUs, compared to preterm infants delivered elsewhere. However, our research found rates as high as 300 percent improvement, when our study design controlled for the effect of sicker patients who typically deliver at high-level NICUs.”
At both types of hospitals, complication rates were similar.
The authors examined records for all births in California and Pennsylvania that occurred between 1995 and 2005, and in Missouri between 1995 and 2003, for their retrospective study. Lorch believed that because the results differed slightly among the states, it could reflect state-level differences in health policies (for example, whether or not the state government designated hospitals within a regional perinatal system).
Premature babies are defined as being born before 37 weeks gestational age (40 weeks is full term). Lorch and team defined extremely preterm infants as being born before 32 weeks. Those born between 32 and 37 weeks, they defined as moderately preterm infants. A high-level NICU, according to the team, is a level III facility that annually delivers at least 50 very low birth weight infants.
“We found survival benefits in high-level NICUs for both extremely premature and moderately premature infants,” he said. “This suggests that the choice of a delivery hospital may influence the outcomes for the full range of preterm infants.”
What makes this study unique, added Lorch, is that it covered more than a single state system. The results may be more generalizable throughout the U.S. than in more limited studies, because this study used hospital data from states in three regions of the country.
He concluded:
“This research does not imply that every hospital should aspire to build a high-tech NICU-there just aren’t enough babies born prematurely for every birth hospital in the U.S. to have a high-level, high-volume NICU. Instead, the results may assist health care policy makers in organizing regional and statewide care systems to more efficiently provide the best care for premature infants within a geographical area.”
Written by Sarah Glynn