Being Born at the Right Place. Mary Boyd, MD, FAAP, President, WV Chapter American Academy of Pediatrics. Risk Appropriate Perinatal Care. Healthy People 2020 Goals. Case Study. Story of a birth of twins. National Performance Measure #17. Percent of VLBW (<1500 gram) infants
Mary Boyd, MD, FAAP,
President, WV Chapter
American Academy of Pediatrics
Healthy People 2020 Goals
Story of a birth of twins
Percent of VLBW (<1500 gram) infants
Level III Perinatal Facilities
(This has been measured for about 30 years)
90% of VLBW Babies Should be born at Level III Perinatal Facilities
Shown in multiple studies since 2004 including:
Preterm Delivery, Level of Care, and Infant Death in Sweden: A Population-Based Study
Stefan Johansson, MD*, ,Scott M. Montgomery, MD, PhD ,Anders Ekbom, MD, PhD ,Petra OtterbladOlausson, PhD||, Fredrik Granath, PhD ,Mikael Norman, MD, PhD*, Sven Cnattingius, MD, PhD
* Women and Child HealthMedical Epidemiology and BiostatisticsClinical Epidemiology Unit, KarolinskaInstitutet|| National Board of Health and Welfare, Stockholm, Sweden
Results. The rate of infant mortality increased from 5% amonginfants born at 31 weeks’ gestation to 56% among infantsborn at 24 weeks’ gestation. Compared with infants bornat university hospitals, the unadjusted odds ratio (OR) of infantdeath was 0.70 (95% confidence interval [CI]: 0.54–0.90)among infants delivered at general hospitals. However, afteradjustment, the OR of infant death shifted to 1.33 (95% CI:0.88–2.02) for preterm births at general hospitals. Thisshift was primarily due to different gestational age distributionsin regional and general hospitals. Among infants born at 24to 27 weeks’ gestation, infant mortality rates were 23%(87 deaths) in university hospitals and 32% (73 deaths) in generalhospitals.
TABLE 4. A Population-Based Study Unadjusted Neonatal Outcomes by Location of Birth
Study done in Cincinnati; SPC=Specialty Perinatal Center
Study done at George Washington University A Population-Based Study
Lasswell SM, Barfield WD, Rochat RR, Blackmon LR.
JAMA 2010; 304.9: 992-1000
Results A Population-Based Study
VLBW and very preterm infants born outside of a level III hospital are at an increased likelihood of neonatal death or death prior to discharge from the hospital.
The researchers identified A Population-Based Study 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).
“These recent scientific findings indicate that more work must be done to better understand the impact of risk-appropriate care on babies born too little or too soon. Our regionalized systems must be systematically evaluated to determine effective care of neonates and prevent infant death”.
Wanda Barfield, MD, MPH
CDC/DRH Director and neonatologist
# <1500 gram infants born at Level III facilities
Total # <1500 gram infants born
CAMC - Women & Children's
WVU Children’s Hospital
Locations of WV Birthing Facilities, 2010 must be done to better understand the impact of risk-appropriate care on babies born too little or too soon. Our regionalized systems must be systematically evaluated to determine effective care of neonates and prevent infant death”.
Weirton General, Weirton,
Ohio Valley Medical Center
Monongalia General, Morgantown
Reynolds Memorial, Glen Dale
City Hospital, Martinsburg
Jefferson Memorial, Ranson
United Hospital Center, Clarksburg
Grant Memorial, Petersburg
Pleasant Valley Hospital
WomenCare Birth Center
Davis Memorial, Elkins
St. Mary's Hospital
St. Joseph's, Buckhannon
Cabell Huntington Hospital
Stonewall Jackson Memorial, Weston
CAMC Women’s and Children’s
Thomas Memorial Hospital
Logan General Hospital
Greenbrier Valley Medical Center
Williamson Memorial Hospital
Raleigh General Hospital
Princeton Community Hospital
Welch Community Hospital
Bluefield Regional Medical Center
Lawyers are like other people--fools on the average; but it is easier for an ass to succeed in that trade than any other.-quoted in Sam Clemens of Hannibal, Dixon Wecter
Delivery of an infant less than 32 weeks gestation in an institution without a NICU
1Guidelines for Perinatal Care, 6th Edition, co-published and endorsed by the American Academy of Pediatrics
and American College of Obstetricians and Gynecologists. 2007
Isn’t it worth the price because it’s the right thing to do?
Available on Perinatal Partnership Website
Maternal Transport Log for Community Hospitals is easier for an ass to succeed in that trade than any other.
(Report multiple calls for same patient as separate entries)