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High-level NICUs mean favorable outcomes for preemies

Premature babies are more likely to survive when they are born in high-level NICUs than in hospitals without such facilities, and this benefit is considerably larger than previously reported, according to a study.

The increased likelihood that an extremely premature baby will survive if born in a high-technology, high-volume hospital unit was already known, but the current study, described as the largest to date, revealed a stronger effect. Pediatric researchers who analyzed more than 1.3 million premature births over a 10-year span found that the survival benefits applied not only to extremely preterm babies, but also to moderately preterm newborns.

The research team performed a retrospective study of all hospital-based deliveries of infants with a gestational age between 23 and 37 weeks in Pennsylvania, California and Missouri, for a total of more than 1.3 million births. The study focused on preterm deliveries in high-level NICUs compared with preterm deliveries at all other hospitals.

“Prior studies from the early 1990s found increased survival rates of 30% to 50% among preterm infants delivered at high-level NICUs compared to preterm infants delivered elsewhere,” Scott A. Lorch, MD, the study’s lead author and a neonatologist at The Children’s Hospital of Philadelphia, said in a news release.

“However, our research found rates as high as 300% improvement when our study design controlled for the effect of sicker patients who typically deliver at high-level NICUs.” Complication rates were similar for both types of hospitals.

In the retrospective study, researchers analyzed records for all births occurring between 1995 and 2005 in Pennsylvania and California and all births between 1995 and 2003 in Missouri. Lorch added that the results varied slightly among states, possibly reflecting state-level differences in health policies.

The researchers defined extremely preterm infants as those born before 32 weeks and moderately preterm infants as those born between 32 and 37 weeks. They defined a high-level NICU as a level III facility that delivered at least 50 very low birth-weight infants annually.

“We found survival benefits in high-level NICUs for both extremely premature and moderately premature infants,” Lorch said. “This suggests that the choice of a delivery hospital may influence the outcomes for the full range of preterm infants.”

Unlike many previous analyses of birth outcomes, Lorch said, the current study covered more than a single state system. Using hospital data from states in three regions of the country suggests the results may be more generalizable throughout the United States than in more limited studies, he added.

However, Lorch said, “this research does not imply that every hospital should aspire to build a high-tech NICU; there just aren’t enough babies born prematurely for every birth hospital in the U.S. to have a high-level, high-volume NICU. Instead, the results may assist healthcare policymakers in organizing regional and statewide care systems to more efficiently provide the best care for premature infants within a geographical area.”

The study is scheduled for publication in the journal Pediatrics. To read the abstract and access the study via subscription or purchase, visit http://bit.ly/McpFSm.

By | 2012-07-29T00:00:00-04:00 July 29th, 2012|Categories: Nursing specialties, Specialty|0 Comments

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