Newborn Intensive Care and Neonatal Mortality in Low-Birth-Weight Infants

Abstract

We examined the neonatal mortality rates of low-birth-weight infants (501 to 2250 g) born between 1976 and 1978 in three kinds of hospitals in New York City: those with newborn-intensive-care units (Level 3), those with capabilities for the care of most premature infants (Level 2), and those without any special facilities for premature newborns (Level 1). Among 13,560 singleton low-birth-weight infants, the adjusted neonatal mortality rate for Level 3 hospitals was 128.5 per thousand live births - significantly lower (P less than 0.001) than the rates for both level 2 (168.1) and Level 1 units (163.0). The association of level of care with mortality could not be accounted for by differences between groups in social or demographic status, in prenatal care, or in medical complication of pregnancy. We infer that birth at a Level 3 center lowers neonatal mortality in low-birth-weight infants. However, only 34 per cent of the patients in this study were born in such units.

Factors affecting nursery survival of very low birth weight infants

“…with birthweights < 1500g, has been well documented [14,15,20]. The impact of the VLBW infants on neonatal mortality is dependent both upon the incidence of VLBW infants born and upon survival of these infants.…”

The relation of obstetrical volume and nursery level to perinatal mortality.

“…Most investigators have noted a twofold improvement in outcome for infants under 2500 gm when born in a high technology facility (Level III) compared to birth in a low technology facility (Level 1). [3][4][5][6][7] A close correlate ofhigh technology is volume, since a high volume of patients is required to justify the expense of purchase, maintenance, and staffing of high technology. This high volume is also thought to lead to improved skill in the use ofthe technology.…”

Evidenzbasierte Bedarfsplanung f�r Intensivbetten

“…Einige Arbeiten beziehen sich auf dieses Thema, die Ergebnisse sind gemischt (in der allgemeinen Intensivmedizin Jones/Rowan 1995; Pronovost et al 1999), neigten eher zur Bestäti-gung (Neonatologie -insbes. in Risikofällen Phibbs et al 1996;LeFevre et al 1992;Verloove-Vanhorick et al 1988;Saigal et al 1984;Paneth et al 1982vgl. aber Epstein 2002, ähnlich in der Pädiatrischen Intensivmedizin (Tilford 2000;Pollack et al 1991).…”