Why does it matter?

According to Jensen and Lorch from the University of Pennsylvania and the Children’s Hospital of Philadelphia, choice of delivery hospital has a significant impact on outcome.  These are their summary conclusions:

1.     A birth hospital’s annual volume of deliveries of very low-birth-weight (VLBW) infants has a greater effect on mortality risk than does neonatal intensive care unit (NICU) level. 

2.     When the effects of NICU level and annual volume of VLBW infant deliveries are evaluated simultaneously, the volume of deliveries is the stronger contributor to the risk of:

• death,
• death or severe intraventricular hemorrhage, and
• death or necrotizing enterocolitis among VLBW infants.

3.     Birth at a hospital with 10 or fewer VLBW infant deliveries per year is associated with the highest risk-adjusted probability of:

• death (15.3% [95% CI, 14.4%-16.3%]),
• death or severe intraventricular hemorrhage (17.5% [95% CI, 16.5%-18.6%]), and
• death or necrotizing enterocolitis (19.3% [95% CI, 18.1%-20.4%])

4.     Antenatal transfer of high-risk pregnancies to hospitals with a high-level NICU and a high volume of VLBW infant deliveries may reduce mortality and improve outcomes.

Erik Jensen, Scott Lorch. “Effects of a Birth Hospital’s Neonatal Intensive Care Unit Level and Annual Volume of Very Low-Birth-Weight Infant Deliveries on Morbidity and Mortality. JAMA Pediatrics. 169(8);e151906.  August 3, 2015.