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Tiniest Babies Fare Best at Specialty Hospitals

Study finds twofold risk of death, handicap in general hospitals

MONDAY, Jan. 5, 2004 (HealthDayNews) -- Babies born extremely underweight fare best at hospitals that specialize in their care, a new study shows.

"In the past, there has been an emphasis on regional care for very low birthweight infants," says lead researcher Dr. Barbara Warner, a neonatologist at Cincinnati Children's Hospital Medical Center. However, recently there has been a trend to expand specialty care to more hospitals, she adds.

This expansion has been fueled by competition for patients between hospitals. Greater numbers of specialists and technological advances have also made this expansion possible, Warner adds.

The increased numbers of specialists has led hospitals to expand into this lucrative area. In this way, hospitals increase their reputation and add to their marketing effort, she says.

The problem is that most of these hospitals provide only some of the know-how necessary. "If you don't have the depth of expertise or a sufficient volume of patients, you cannot provide the complete in-depth care needed," Warner says.

To determine whether expanding care for these infants affected their outcome, Warner and her colleagues collected data on 848 births of very low birthweight infants from 19 hospitals in the Cincinnati area between 1995 and 1997.

These infants weighed approximately 1 pound to 3 pounds. The researchers looked at deaths and illness, including lung disease, bleeding in the brain and deterioration of the retina, according to their report in the January issue of Pediatrics.

"We found that these infants had a twofold increase of either dying or in having a major handicapping condition if they are born at a hospital that does not have high levels of specialty care," Warner says.

These findings support the recommendations of the America Academy of Pediatrics that say that if a mother is delivering at less than 32 weeks of gestation, the delivery should be done at a specialty hospital, she adds.

"If you have a term pregnancy and no complications, then many hospitals can meet your needs," Warner says. "But if you have a high-risk pregnancy with the potential of delivering a very low birthweight infant, then you should be at a hospital that provides high-level care for these infants."

Dr. Charles Safran, an associate clinical professor of medicine at the Harvard Medical School, says these findings are not surprising.

"Caring for a 1-pound baby is a miracle of modern American medicine, but this advancement has come at huge cost," Safran says.

Such small infants require specialized care in neonatal intensive care units (NICUs) for prolonged periods -- typically two to three months. "We have only about 800 level 3 [the highest level] NICUs capable of caring for very low birthweight infants in the U.S., and many of these units run at capacity," he adds.

According to Safran, new units and additional NICU space is expensive to build and even harder to staff. "While the article by Warner argues strongly for birthing very low birthweight infants at hospitals with level 3 NICUs, the vast majority of these infants are not identifiable in advance," he notes.

Safran says about 40 percent of very low birthweight infants are the result of poor prenatal care, and about 30 percent are of unknown causes. "The remaining third result from twins and triplets, many of whom are the result of fertility technologies."

"Mothers who are carrying twins or higher-order multiples should deliver at hospitals with Level 3 NICUs, or at least hospitals with neonatologists on staff. These hospitals should also be ready to transport the infant to affiliated centers," Safran advises.

Dr. Marilyn B. Escobedo, a pediatrician at the College of Medicine at the University of Oklahoma, adds "this is new data that supports a long-held tenet of neonatal-perinatal medicine."

"Mother and unborn baby should be treated as one patient who needs a continuum of expertise," Escobedo says. "Maternal transport is better medicine than neonatal transport, and fewer, larger obstetrical services with high-level neonatal services benefit the very premature more than many smaller obstetrical services that have less experience with the very premature babies."

More information

To learn more about low birthweight infants and child care, visit the Mayo Clinic. Get tips on a healthy pregnancy from the March of Dimes.

SOURCES: Barbara Warner, M.D., Department of Pediatrics, Division of Neonatology, Cincinnati Children's Hospital Medical Center; Charles Safran, M.D., associate clinical professor, medicine, Harvard Medical School, Boston; Marilyn B. Escobedo, M.D., chief, Section of Neonatal Perinatal Medicine, Department of Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City; January 2004 Pediatrics
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