High-risk premature babies who are born in hospitals with high-level neonatal intensive care units (high-level NICU) fare better than high-risk newborns born in other hospital settings, says a new study published in the August 2012 issue of the journal Pediatrics.
Previous data has suggested that giving birth in a high-volume, high-technology hospital with a high-level NICU offers the best outcome for high-risk babies. However, no study had yet examined the effect of delivery hospital on the outcomes of premature babies.
Researchers at the The Children’s Hospital of Philadelphia and The University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania thus sought to determine the effects, if any, on hospital type (high-level NICU or otherwise) on reducing neonatal mortality rates.
For the study, the researchers performed a retrospective population-based cohort study. The researchers looked at data from all hospital-based deliveries in Pennsylvania and California between the years 1995 and 2005 and Missouri between the years 1995 and
2003. All of the babies considered for the study were born between 23 and 37 weeks of gestation. A total of 1,328,132 births were included in the ﬁnal cohort. Hospital type including hospitals with a high-level NICU were noted.
Compounding factors including gestational age; birth weight; maternal sociodemographic factors such as race, age, education, and insurance status; maternal comorbid conditions; and 49 congenital anomalies were also taken into consideration when analyzing the effect of hospitals including those with a high-level NICU on the outcome of premature babies.
The researchers examined neonatal death rates as well as 5 other complications of premature birth to determine if hospital setting had an effect on outcome.
According to the study, premature babies born in high-level NICU hospitals had signiﬁcantly fewer in-hospital neonatal deaths in all three states. Furthermore, women who gave birth in a high-level NICU hospital were more likely to have either a pre-existing comorbid condition such as gestational diabetes or a complication of pregnancy such as preterm labor. Babies who were born in high-level NICU hospitals had a younger gestational age on average.
In unadjusted analyses, hospitals with a high-level NICU had higher neonatal death rates. However, after adjusting for factors such as gestational age at birth and other compounding complications and factors, the researchers discovered that delivering at a high-level NICU hospital offered better outcomes for premature babies than premature babies born in other hospital settings.
As the researchers concluded:
“In conclusion, our work suggests that the survival beneﬁt to delivering at a high-level NICU between 1995 and 2005 is larger than previously reported and appears to beneﬁt both extremely preterm and moderately preterm infants.”
However, regional differences existed between the states, which may be attributable to different methods of regionalization.
Are you surprised that premature babies born at hospitals with a high-level NICU fare better than premature babies born in other hospital settings?