Among obstetricians and neonatologists in administrative roles in New York City hospitals, a survey was initiated to compare the physicians' definitions of live birth and fetal death, the gestational age at which they consider infants viable, and the resuscitation practices of the neonatologists. The target survey population was 34 neonatologists, and 39 obstetricians representing 41 of the City's 43 maternity hospitals. A telephone survey was used to gather qualitative data from the physicians regarding their definitions of live birth, fetal death, and viability, and their practices regarding extremely premature births. Surveys were completed for 58 physicians, a response rate of 79% (94% for neonatologists and 67% for obstetricians). Physicians' definitions of live birth and fetal death varied, with almost a third (29%) of physicians including gestational age as part of their live birth criteria. Most of the physicians (90%) consider infants born at ≥23 weeks gestation viable. Most neonatologists (97%) said they always resuscitate infants born at ≥23 weeks gestation, and most (94%) said they would never resuscitate infants born at <20 weeks gestation. For infants born at 20-22 weeks gestation, there were differences in resuscitation practices. There is a gap between clinical practices and reporting requirements for live birth and fetal death. Whereas reporting requirements are based on definitions of live birth and fetal death, physicians make resuscitation and other clinical decisions regarding extremely premature infants based on definitions of viability.

No abstract

A factor often ignored in analyses of neonatal mortality rate is the reporting practices of hospitals. This study examined hospital reporting practices by comparing hospitals where the reporting requirement of New York City Department of Health was followed and all births were reported regardless of gestational age and hospitals where gestational age was taken into account in the reporting.In 2008, a survey was conducted among neonatologists in charge of neonatal intensive care units and obstetricians in charge of departments of obstetrics in New York City maternity hospitals. The survey collected information on hospitals' definitions of live birth and fetal death, their resuscitation practices for extremely premature infants, and their reporting practices for live births and infant deaths.Data from the 2008 survey and New York City's linked live birth/neonatal death data sets for 2007-2009 were used to examine the impact of hospitals' reporting practices on neonatal mortality rate. The neonatal mortality rate for hospitals where gestational age was taken into account was significantly lower than the hospitals where all live births were reported regardless of gestational age (2.68 versus 3.54, p=0.0033). Removal of infants born at less than 23 weeks gestation resulted in almost equal neonatal morality rates (2.53 versus 2.77, p=0.41).When the data was separated by race and insurance coverage, the difference in reporting practices resulted in significantly lower neonatal morality for births to white mothers (p=0.0032) and women covered by Medicaid (p=0.0005).

No abstract

No abstract