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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
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
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.