PEDIATRICS Vol. 109 No. 5 May 2002, pp. 745-751
Mortality in Low Birth Weight Infants According to Level of Neonatal Care at Hospital of Birth
* Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Health Economics Resource Center, Center for Health Care Evaluation, and Cooperative Studies Program, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Health Research and Policy, Stanford University, Stanford, California
|| Department of Pediatrics and Cardiovascular Research Institute, University of California, San Francisco, California
¶ Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
--> Objective. In 1976, the Committee on Perinatal Health recommended that hospitals with no neonatal intensive care unit (NICU) or intermediate NICUs transfer high-risk mothers and infants that weigh <2000 g to a regional NICU. This standard was based on expert opinion and has not been validated carefully. This study evaluated the effect of NICU level and patient volume at the hospital of birth on neonatal mortality of infants with a birth weight (BW) of <2000 g.
Methods. Birth certificates of 16 732 singleton infants who had a BW of <2000 g and were born in nonfederal hospitals in California in 1992 and 1993 were linked to death certificates and to discharge abstracts. The hospitals were classified by the level of NICU: no NICU, no intensive care; intermediate NICU, intermediate intensive care; community NICU, expanded intermediate intensive care; and regional NICU, tertiary intensive care. A logistic regression model that controlled for demographic risks, diagnoses, transfer, average NICU census, and NICU level was estimated using death within the first 28 days or first year of life if continuously hospitalized as the main outcome measure.
Results. Compared with birth in a hospital with a regional NICU, risk-adjusted mortality of infants with BW of <2000 g was higher when birth occurred in hospitals with no NICU (odds ratio [OR]: 2.38; 95% confidence interval [CI]: 1.81–3.13), an intermediate NICU (OR: 1.92; 95% CI: 1.44–2.54), or a small (average census <15) community NICU (OR: 1.42; 95% CI: 1.14–1.76). Risk-adjusted mortality for infants who were born in hospitals with a large (average census 
15) community NICU was not statistically different compared with those with a regional NICU (OR: 1.11; 95% CI: 0.87–1.43). Except for large community NICUs, all of these ORs are larger when the data are restricted to infants with BW of <1500 g or BW of <1250 g and smaller for BW between 1250 g and 1999 g and 1500 g and 1999 g. For large community NICUs, the results are similar for the smaller BW intervals and significant only for the larger BW interval.
Conclusions. These results support the recommendation that hospitals with no NICU or intermediate NICUs transfer high-risk mothers with estimated fetal weight of <2000 g to a regional NICU. For infants with BW of <2000 g, birth at a hospital with a regional NICU is associated with a lower risk-adjusted mortality than birth at a hospital with no NICU, intermediate NICU of any size, or small community NICU. Subsequent neonatal transfer to a regional NICU only marginally decreases the disadvantage of birth at these hospitals. The evidence for the few hospitals with large community NICUs is mixed. Although the data point to higher mortality in large community NICUs, they are not conclusive and additional study is needed on the mortality effects of large community NICUs. Greater efforts should be made to deliver infants with expected BW of <2000 g at hospitals with regional NICUs.
Key Words: infant • low birth weight • hospital mortality • vital statistics • health care surveys • intensive care units
Abbreviations: NICU, neonatal intensive care unit • BW, birth weight • OSHPD, Office of Statewide Health Planning and Development • ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification • OR, odds ratio • CI, confidence interval • VLBW, very low birth weight
Received for publication Feb 15, 2001; Accepted Nov 20, 2001.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  K. M. McDonald, S. M. Davies, C. A. Haberland, J. J. Geppert, A. Ku, and P. S. Romano Preliminary Assessment of Pediatric Health Care Quality and Patient Safety in the United States Using Readily Available Administrative Data Pediatrics, August 1, 2008; 122(2): e416 - e425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Qian, C. Liu, W. Zhuang, Y. Guo, J. Yu, H. Chen, S. Wang, Z. Lin, S. Xia, L. Ni, et al. Neonatal Respiratory Failure: A 12-Month Clinical Epidemiologic Study From 2004 to 2005 in China Pediatrics, May 1, 2008; 121(5): e1115 - e1124. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Howell, P. Hebert, S. Chatterjee, L. C. Kleinman, and M. R. Chassin Black/White Differences in Very Low Birth Weight Neonatal Mortality Rates Among New York City Hospitals Pediatrics, March 1, 2008; 121(3): e407 - e415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Kahn, W. T. Linde-Zwirble, H. Wunsch, A. E. Barnato, T. J. Iwashyna, M. S. Roberts, J. R. Lave, and D. C. Angus Potential Value of Regionalized Intensive Care for Mechanically Ventilated Medical Patients Am. J. Respir. Crit. Care Med., February 1, 2008; 177(3): 285 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Van Reempts, L. Gortner, D. Milligan, M. Cuttini, S. Petrou, R. Agostino, D. Field, L. den Ouden, K. Borch, J. Mazela, et al. Characteristics of Neonatal Units That Care for Very Preterm Infants in Europe: Results From the MOSAIC Study Pediatrics, October 1, 2007; 120(4): e815 - e825. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. F. Bell, D. G. Batton, A. R. Stark, and On behalf of the American Academy of Pediatrics Co Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns: In Reply Pediatrics, June 1, 2007; 119(6): 1267 - 1269. [Full Text] [PDF]
|
|
|
|
 |
|
 C. S. Phibbs, L. C. Baker, A. B. Caughey, B. Danielsen, S. K. Schmitt, and R. H. Phibbs Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants N. Engl. J. Med., May 24, 2007; 356(21): 2165 - 2175. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Haberland, C. S. Phibbs, and L. C. Baker Effect of Opening Midlevel Neonatal Intensive Care Units on the Location of Low Birth Weight Births in California Pediatrics, December 1, 2006; 118(6): e1667 - e1679. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Kahn, C. H. Goss, P. J. Heagerty, A. A. Kramer, C. R. O'Brien, and G. D. Rubenfeld Hospital volume and the outcomes of mechanical ventilation. N. Engl. J. Med., July 6, 2006; 355(1): 41 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Bartels, D. Wypij, P. Wenzlaff, O. Dammann, and C. F. Poets Hospital volume and neonatal mortality among very low birth weight infants. Pediatrics, June 1, 2006; 117(6): 2206 - 2214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Morales, D. Staiger, J. D. Horbar, J. Carpenter, M. Kenny, J. Geppert, and J. Rogowski Mortality Among Very Low-Birthweight Infants in Hospitals Serving Minority Populations Am J Public Health, December 1, 2005; 95(12): 2206 - 2212. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Markestad, P. I. Kaaresen, A. Ronnestad, H. Reigstad, K. Lossius, S. Medbo, G. Zanussi, I. E. Engelund, R. Skjaerven, L. M. Irgens, et al. Early Death, Morbidity, and Need of Treatment Among Extremely Premature Infants Pediatrics, May 1, 2005; 115(5): 1289 - 1298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Committee on Fetus and Newborn Levels of Neonatal Care Pediatrics, November 1, 2004; 114(5): 1341 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Rogowski, D. O. Staiger, and J. D. Horbar Variations In The Quality Of Care For Very-Low-Birthweight Infants: Implications For Policy Health Aff., September 1, 2004; 23(5): 88 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Johansson, S. M. Montgomery, A. Ekbom, P. O. Olausson, F. Granath, M. Norman, and S. Cnattingius Preterm Delivery, Level of Care, and Infant Death in Sweden: A Population-Based Study Pediatrics, May 1, 2004; 113(5): 1230 - 1235. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Rogowski, J. D. Horbar, D. O. Staiger, M. Kenny, J. Carpenter, and J. Geppert Indirect vs Direct Hospital Quality Indicators for Very Low-Birth-Weight Infants JAMA, January 14, 2004; 291(2): 202 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Warner, M. J. Musial, T. Chenier, and E. Donovan The Effect of Birth Hospital Type on the Outcome of Very Low Birth Weight Infants Pediatrics, January 1, 2004; 113(1): 35 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Dougherty and L. A. Simpson Measuring the Quality of Children's Health Care: A Prerequisite to Action Pediatrics, January 1, 2004; 113(1/S1): 185 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Clark, J. Cifuentes, J. Bronstein, C. S. Phibbs, S. K. Schmitt, R. H. Phibbs, and W. A. Carlo Mortality in Low Birth Weight Infants According to Level of Neonatal Care at Hospital of Birth Pediatrics, July 1, 2003; 112(1): 203 - 204. [Full Text] [PDF]
|
|
|
|
 |
|
 L. R. Blackmon The Role of the Hospital of Birth on Survival of Extremely Low-birthweight, Extremely Preterm Infants NeoReviews, June 1, 2003; 4(6): e147 - 152. [Full Text] [PDF]
|
|
|
|
 |
|
 C. S Phibbs Commentary: Does patient volume matter for low-risk deliveries? Int. J. Epidemiol., October 1, 2002; 31(5): 1069 - 1070. [Full Text] [PDF]
|
|
|
|
 |
|
 Neonatologists and Neonatal ICUs - What is the Best Mix? Journal Watch Pediatrics and Adolescent Medicine, July 15, 2002; 2002(715): 8 - 8. [Full Text]
|
|
|
|
 |
|
 Regionalization of Neonatal Care Saves Lives Journal Watch (General), May 17, 2002; 2002(517): 7 - 7. [Full Text]
|
|
