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Neonatal Mortality Risk Higher at Unspecialized Hospitals

Very low-birth-weight, very preterm infants more likely to survive if born at level III facilities

TUESDAY, Aug. 31 (HealthDay News) -- Very low-birth-weight (VLBW) and very preterm (VPT) infants born at hospitals without specialized neonatal care have higher mortality risks than those born at specialized level III hospitals, according to a meta-analysis published in the Sept. 1 issue of the Journal of the American Medical Association.

Sarah Marie Lasswell, of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues searched the medical literature from 1976 to 2010 for studies of predischarge or neonatal mortality among infants weighing 1,500 g or less or born at 32 weeks' gestation or earlier. The reviewers analyzed 41 studies and pooled data to compare mortality risk for those delivered at a specialized level III hospital and those delivered at a lower-level hospital.

The researchers found a higher mortality risk for VLBW infants born at lower-level compared to level III hospitals (adjusted odds ratio [aOR], 1.62), as well as for VPT infants born at lower-level hospitals (aOR, 1.55). The elevated mortality risks were consistent when the analysis was limited to higher-quality evidence (aORs, 1.60 for VLBW infants, 1.42 for VPT infants, and 1.80 for infants weighing less than 1,000 g).

"Although they represent less than 2 percent of U.S. births, 55 percent of infant deaths occur among VLBW infants. Strengthening perinatal regionalization systems in states with high percentages of VLBW and VPT infants born outside of level III centers could potentially save thousands of infant lives every year," the authors write.

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