Very low-birth-weight and very preterm infants not born in highly specialized, level III hospitals have an associated higher likelihood of neonatal and predischarge death compared to similar infants born at level III hospitals, according to an article in the September 1 issue of JAMA.
"For more than 30 years, guidelines for perinatal [pertaining to the period immediately before and after birth] regionalization have recommended that very low-birth-weight (VLBW) infants be born at highly specialized hospitals, most commonly designated as level III hospitals. Despite these recommendations, some regions continue to have large percentages of VLBW infants born in lower-level hospitals," according to background information in the article.
Sarah Marie Lasswell, M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a meta-analysis of previous research to examine the relationship between hospital level at birth and neonatal (generally the first four weeks after birth) or predischarge mortality for VLBW (1,500 grams [53 ounces] or less) and very preterm (VPT; 32 weeks or less gestation) infants to determine the importance of level of care at birth to survival. The researchers identified 41 publications that met criteria to be included in the study.
Analysis of the data of the VLBW studies (n = 37; 104,944 infants) indicated a 62 percent increase in odds of neonatal/predischarge death for infants born in non-level III hospitals compared with those born in level III hospitals (38 percent vs. 23 percent). When restricted to only higher-quality evidence (9 publications; 46,318 infants), a 60 percent increase in the odds of neonatal and/or predischarge mortality was estimated for VLBW infants born at non-level III hospitals (36 percent vs. 21 percent). Also, extremely low-birth-weight infants (1,000 grams [35 ounces] or less) born in non-level III hospitals had an estimated 80 percent increase in odds of neonatal and/or predischarge mortality compared with those born at level III hospitals (59 percent vs. 32 percent).
