Effect of Opening Midlevel Neonatal Intensive Care Units on the Location of Low Birth Weight Births in California

Haberland, Corinna; Phibbs, Ciaran S.; Baker, Laurence C.

doi:10.1542/peds.2006-0612

Cited by 36 publications

(21 citation statements)

References 33 publications

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“…The availability of obstetricians in a county and the presence of hospitals reporting the ability to provide more complex services, although they had no local neonatologists, were associated with a lower likelihood that women with preterm births delivered in neonatology-staffed NICU. This verifies the findings of others (Gould et al 1999;Haberland, Phibbs, and Baker 2006) that perceived local expertise reduces the likelihood of use of more appropriate delivery facilities, and the finding persisted when examining only births at o33 weeks gestation. As the overall trend analysis suggested, there were no significant associations between the ANGELS intervention and delivery at an NICU.…”

Section: Discussionsupporting

confidence: 86%

“…Over the past two decades there has been an increase in the number of hospitals claiming to provide neonatal intensive care at some level, even if they have a relatively low volume of patients and lack full-time coverage by neonatologists (Richardson, Reed, and Cutler 1995;Goodman et al 2001;Howell et al 2002). Perinatal regionalization to tertiary settings is reduced in locales with more availability of intermediate NICU hospital settings because of shifts in obstetrics referral patterns (Powell et al 1995;Gould et al 1999;Haberland, Phibbs, and Baker 2006;Zeitlin et al 2008).…”

Section: Perinatal Regionalization As a Physician Referral Behaviormentioning

confidence: 99%

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Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention

Bronstein

Ounpraseuth

Jonkman

et al. 2011

Health Services Research

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Objective. To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001-2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice. Data Sources. A dataset of linked Medicaid claims and birth certificates for the time period by clustering Medicaid claims by pregnancy episode. Pregnancy episodes were linked to residential county-level demographic and medical resource characteristics. Deliveries occurring before 35 weeks gestation (n 5 5,150) were used for analysis. Study Design. Logistic regression analysis was used to examine time trends and individual, county, and intervention characteristics associated with delivery at hospitals with NICU, and delivery at the academic medical center. Principal Findings. Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting. Conclusion. Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

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Section: Discussionsupporting

confidence: 86%

Section: Perinatal Regionalization As a Physician Referral Behaviormentioning

confidence: 99%

Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention

Bronstein

Ounpraseuth

Jonkman

et al. 2011

Health Services Research

View full text Add to dashboard Cite

show abstract

“…It results in less‐severe lung disease and fewer related complications, including fewer cases of intraventricular haemorrhage and chronic lung disease 19–21 . Transfer of the pregnant woman to a tertiary level centre for very preterm delivery is also associated with higher levels of survival 22–24 . The use of caesarean section for very preterm deliveries in the absence of other obstetric indications is controversial and there is an ongoing debate about its impact on very preterm survival and morbidity 25–27 .…”

Section: Discussionmentioning

confidence: 99%

Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study

Kollée

Cuttini

Delmas

et al. 2009

BJOG

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Objective To describe obstetric intervention for extremely preterm births in ten European regions and assess its impact on mortality and short term morbidity.Design Prospective observational cohort study. Main outcome measures Use of antenatal corticosteroids, antenatal transfer and caesarean section by two-week gestational age groups as well as a composite score of these three interventions. Outcomes included stillbirth, in-hospital mortality and intraventricular haemorrhage (IVH) grades III and IV and/or periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD).Results There were large differences between regions in interventions for births at 22-23 and 24-25 weeks. Differences were most pronounced at 24-25 weeks; in some regions these babies received the same care as babies of 28-29 weeks, whereas elsewhere levels of intervention were distinctly lower. Before 26 weeks and especially at 24-25 weeks, there was an association between the composite intervention score and mortality. No association was observed at 26-27 weeks. For survivors at 24-25 weeks, the intervention score was associated with higher rates of BPD, but not with IVH or PVL.Conclusions There are large differences between European regions in obstetric practices at the lower limit of viability and these are related to outcome, especially at 24-25 weeks.

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“…However, despite more units, access to care for low birth weight infants in California has not appreciably changed, as evidenced by a small reduction in deliveries in lowerlevel units. 6 Instead, it has resulted in the diffusion of delivery volume from centralized, higher-level units to the more abundant, midlevel units. If hospital volume, rather than the level of care or the presence of hospital specialty services, is the primary factor for improved outcomes for high-risk pregnancies and newborns, then this trend is certainly worrisome.…”

Section: Introductionmentioning

confidence: 99%

Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

et al. 2011

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Objective: The objective of this study was to examine the effect of hospitallevel factors on mortality of very low birth weight infants using multilevel modeling.Study Design: This is a secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002. The study population was limited to singleton, non-anomalous, very low birth weight infants, who delivered in hospitals providing neonatal intensive care services (level-2 and higher). Hierarchical generalized linear modeling, also known as multilevel modeling, was used to adjust for individual-level confounders.Result: In a multilevel model, increasing hospital volume of very low birth weight deliveries was associated with lower odds of very low birth weight mortality. Characteristics of a particular hospital's obstetrical and neonatal services (the presence of residency and fellowship training programs and the availability of perinatal and neonatal services) had no independent effect. Conclusion: Using multilevel modeling, hospital volume of very low birth weight deliveries appears to be the primary driver of reduced mortality among very low birth weight infants.

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Effect of Opening Midlevel Neonatal Intensive Care Units on the Location of Low Birth Weight Births in California

Cited by 36 publications

References 33 publications

Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention

Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention

Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study

Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

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