Preemies Do Best at Experienced Medical Centers

Study suggests hospitals should pool resources to create top neonatal centers

WEDNESDAY, May 23, 2007 (HealthDay News) -- Extremely premature babies are 1.2 to 2.7 times more likely to die if they're born at hospitals with the least resources for their care, compared to hospitals with the most resources.

That's the conclusion of a study of California births that is published in the May 24 issue of the New England Journal of Medicine.

"Where you're born makes a huge difference," said study lead author Ciaran Phibbs, associate professor of pediatrics at Stanford University School of Medicine. "The take-home message for moms is that if you think you're in trouble, and you're at a very early gestation, you want to get out of a small hospital."

About 12.5 percent of U.S. babies are born before 37 weeks of gestation, although Phibbs said those born just a few weeks early may not need much more than monitoring. But about 1 percent are born at 32 weeks and earlier.

The number of premature babies has been growing, possibly as a result of fertility treatments that result in more multiple births. "When you have triples or above, you get more preemies," Phibbs said. "There isn't room, so they pop out early."

In the new study, Phibbs and colleagues tried to determine if the hospitals the babies were born in affected their chances of survival.

They looked at babies who were between 500 grams and 1,500 grams (the latter is 3.3 pounds, roughly the equivalent of 32 weeks of gestation), and born in California between 1991 and 2000. A total of 48,237 babies were studied.

The researchers found that the babies were most likely to survive if they were born in hospitals with the most advanced neonatal units, defined as those that treat more than 100 "ultra-low-weight" premature babies a year and provide a variety of advanced medical services for them.

"If you're born in a place that's really geared up to care for these kids, they're a lot better than if you're not born in one of those places," Phibbs said. However, fewer than a quarter of the preemies studied were born in the most advanced hospitals, and that number dropped over the period studied.

It may seem logical that experienced hospitals would do better than other ones, but "people appear to have been resisting this idea, presumably for competitive reasons," said Dr. Ann Stark, chief of neonatology at Baylor College of Medicine and Texas Children's Hospital.

What to do? Phibbs said hospitals, particularly neighboring ones in urban areas, should consolidate their resources to provide the most advanced therapies and technologies and most experienced staff. "There are a lot of hospitals running small programs that are close to one another" and could combine them, he said.

According to Phibbs, 92 percent of the babies in the study were born in urban areas that could consolidate their resources into at least one top-notch neonatal center that would get plenty of cases.

"It'll be difficult to do because of all the egos involved," Phibbs said. "It'll be difficult to pull off in most settings."

More information

Learn more about premature babies from the U.S. National Institutes of Health.

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