BACKGROUND: Because greater percentages of women deliver at hospitals without high-level NICUs, there is little information on the effect of delivery hospital on the outcomes of premature infants in the past 2 decades, or how these effects differ across states with different perinatal regionalization systems.
METHODS: A retrospective population-based cohort study was constructed of all hospital-based deliveries in Pennsylvania and California between 1995 and 2005 and Missouri between 1995 and 2003 with a gestational age between 23 and 37 weeks (N = 1 328 132). The effect of delivery at a high-level NICU on in-hospital death and 5 complications of premature birth was calculated by using an instrumental variables approach to control for measured and unmeasured differences between hospitals.
RESULTS: Infants who were delivered at a high-level NICU had significantly fewer in-hospital deaths in Pennsylvania (7.8 fewer deaths/1000 deliveries, 95% confidence interval [CI] 4.1–11.5), California (2.7 fewer deaths/1000 deliveries, 95% CI 0.9–4.5), and Missouri (12.6 fewer deaths/1000 deliveries, 95% CI 2.6–22.6). Deliveries at high-level NICUs had similar rates of most complications, with the exception of lower bronchopulmonary dysplasia rates at Missouri high-level NICUs (9.5 fewer cases/1000 deliveries, 95% CI 0.7–18.4) and higher infection rates at high-level NICUs in Pennsylvania and California. The association between delivery hospital, in-hospital mortality, and complications differed across the 3 states.
CONCLUSIONS: There is benefit to neonatal outcomes when high-risk infants are delivered at high-level NICUs that is larger than previously reported, although the effects differ between states, which may be attributable to different methods of regionalization.
- BPD —
- bronchopulmonary dysplasia
- CI —
- confidence interval
- ICD-9-CM —
- International Classification of Diseases, Ninth Revision, Clinical Modification
- NEC —
- necrotizing enterocolitis
- ROP —
- retinopathy of prematurity
- RR —
- risk ratio
- Accepted April 2, 2012.
- Copyright © 2012 by the American Academy of Pediatrics