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New AHCPR-Funded Study on Neonatal Mortality Published in JAMA

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Media Advisory Date: October 1, 1996

High-risk babies could have an increased chance of survival if they are delivered in hospitals with level III neonatal intensive care units (NICU), with no significant increase in the cost of care. This was the finding of a study funded by the Agency for Health Care Policy and Research (AHCPR), published in the October 2 issue of The Journal of the American Medical Association (JAMA).

The researchers found that level III NICUs reduced by 38 percent the high-risk infant's chance of dying, compared with infants born in a hospital without an NICU. They also found that there was not a significant difference in risk of mortality between hospitals with a lower level NICU (levels II and II+) and those hospitals without any NICU. Level III NICUs are defined as regional or tertiary care centers that provide a full range of specialized neonatal care, including subspecialty consultants and surgery, and treat more than 15 patients a day. The study examined 476,973 single births in non-Federal hospitals in California in 1990 which were successfully linked with hospital discharge data. Of these, 53,229 infants were classified as likely NICU admissions.

Researchers also suggest that the rapid increase in the number of level II and level II+ NICUs in California in the 1980s may have resulted in a higher neonatal mortality rate than if high-risk deliveries had been concentrated in hospitals with existing level III NICUs. Since most of the hospitals with level II or level II+ NICUs were located in urban areas that also contained a hospital with a level III NICU, the researchers believe "it should be possible to concentrate most high-risk deliveries at hospitals with a level III NICU without imposing serious problems of geographic access to care for patients in those urban areas."

In addition, the findings suggest that referrals and/or transport of high-risk expectant women to hospitals with level III NICUs will yield better outcomes than later transport of infants. However, researchers call for more study on the link between obstetric condition and neonatal outcome.

The study, entitled "The Effects of Patient Volume and Level of Care at the Hospital of Birth on Neonatal Mortality," conducted by Ciaran S. Phibbs, Ph.D., of the VA Palo Alto Health Care System and colleagues, is a component of AHCPR's Patient Outcomes Research Team for the Prevention of Low Birth Weight in High-Risk and Minority Women, based at University of Alabama at Birmingham.

For more information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864, or Karen Carp, (301) 427-1858.

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