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Previous Volume 356:2165-2175 May 24, 2007 Number 21 Next

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ABSTRACT

Background There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units. We examined differences in neonatal mortality among infants with very low birth weight (below 1500 g) among NICUs with various levels of care and different volumes of very-low-birth-weight infants.

Methods We linked birth certificates, hospital discharge abstracts (including interhospital transfers), and fetal and infant death certificates to assess neonatal mortality rates among 48,237 very-low-birth-weight infants who were born in California hospitals between 1991 and 2000.

Results Mortality rates among very-low-birth-weight infants varied according to both the volume of patients and the level of care at the delivery hospital. The effect of volume also varied according to the level of care. As compared with a high level of care and a high volume of very-low-birth-weight infants (more than 100 per year), lower levels of care and lower volumes (except for those of two small groups of hospitals) were associated with significantly higher odds ratios for death, ranging from 1.19 (95% confidence interval [CI], 1.04 to 1.37) to 2.72 (95% CI, 2.37 to 3.12). Less than one quarter of very-low-birth-weight deliveries occurred in facilities with NICUs that offered a high level of care and had a high volume, but 92% of very-low-birth-weight deliveries occurred in urban areas with more than 100 such deliveries.

Conclusions Mortality among very-low-birth-weight infants was lowest for deliveries that occurred in hospitals with NICUs that had both a high level of care and a high volume of such patients. Our results suggest that increased use of such facilities might reduce mortality among very-low-birth-weight infants.

Source Information

From the Health Economics Resource Center and the Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA (C.S.P., S.K.S.); the Department of Pediatrics (C.S.P.) and the Department of Health Research and Policy and the Center for Primary Care Outcomes Research (C.S.P., L.C.B.), Stanford University School of Medicine, Stanford, CA; the National Bureau for Economic Research, Cambridge, MA (L.C.B.); the Department of Obstetrics and Gynecology (A.B.C.) and the Department of Pediatrics and the Cardiovascular Research Institute (R.H.P.), University of California, San Francisco; and Health Information Solutions, Rocklin, CA (B.D.).

Address reprint requests to Dr. C. Phibbs at the Health Economics Resource Center (152), VA Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA 94025, or at cphibbs{at}stanford.edu.

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