Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e257-e263 (doi:10.1542/peds.2006-1964)

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ARTICLE

The Effect of Birth in Secondary- or Tertiary-Level Hospitals in Finland on Mortality in Very Preterm Infants: A Birth-Register Study

Liisi Rautava, BM^a, Liisa Lehtonen, MD, PhD^a, Mikko Peltola, MSc^b, Emmi Korvenranta, MSc (Econ), BM^a, Heikki Korvenranta, MD, PhD^a, Miika Linna, PhD^b, Mikko Hallman, MD, PhD^d, Sture Andersson, MD, PhD^e, Mika Gissler, DrPhil, MSocSci^f, Jaana Leipälä, MD, PhD^g, Outi Tammela, MD, PhD^h, Unto Häkkinen, PhD^b for the PERFECT Preterm Infant Study Group

^a Department of Pediatrics, Turku University Hospital, Finland
^b Centre for Health Economics
^f Information Division, National Research and Development Centre for Welfare and Health, Helsinki, Finland
^d Department of Pediatrics, Oulu University Hospital, Oulu, Finland
^e Department of Pediatrics, Hospital for Children and Adolescents, Helsinki, Finland
^g Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
^h Department of Pediatrics, Tampere University Hospital, Tampere, Finland

OBJECTIVE. Our goal was to test the hypothesis that the level of the delivery hospital affects 1-year mortality of very preterm infants in Finland.

PATIENTS AND METHODS. This retrospective national medical birth-register study included 2291 very preterm infants (gestational age of <32 weeks at birth or birth weight of 1500 g) born in 14 level II (central) and 5 level III (university) hospitals in 2000–2003. The main outcome measures were adjusted total mortality (including stillbirths) and mortality of live-born infants until the age of 1 year.

RESULTS. Both the total 1-year mortality and the 1-year mortality of live-born infants were higher in level II hospitals compared with level III hospitals. Total mortality was higher in very preterm infants who were not born during office hours. In theory, delivery of all very preterm infants in level III instead of level II hospitals translates into an annual prevention of 69 of the 170 total deaths and prevention of 18 of the 45 deaths of live-born infants.

CONCLUSIONS. Resources in neonatal intensive care should be increased, especially during non–office hours, to have an equally distributed service through the 24-hour day. More efficient regionalization of very preterm deliveries may improve 1-year survival of very preterm infants in Finland.

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Key Words: very preterm infant • VLBW infant • mortality • hospital level • regionalization • time of birth

Abbreviations: MBR—Medical Birth Register • SGA—small for gestational age • AGA—appropriate for gestational age • LGA—large for gestational age • OR—odds ratio • CI—confidence interval

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Accepted Aug 10, 2006.

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