The relationship between neonatal mortality and hospital level

The relative safety of the small obstetrics unit compared with that of the larger or more technologically sophisticated units remains controversial. The purpose of this study was to examine the relationship between neonatal mortality and the level of perinatal services present in the hospital of birth.

Logistic regression was used to model neonatal mortality as a function of race, weight, and hospital level. Hospitals were classified into five categories using the volume of deliveries and the level of perinatal services available.

Both black and white infants born at Level I-A hospitals who weighed less than 2250 (5 lb) fared worse than those born at Level III hospitals. There were no other statistically significant differences between the remaining hospital levels at any weight, although there was a trend toward improved mortality for white babies weighing less than 1500 g (3 lb, 5 oz) born at Level III centers. Level II-B hospitals, which also had neonatal intensive care available, did not demonstrate this trend.

The results of this study support the safety of facilities with lower levels of care for delivery of normal birthweight infants and the need for continued centralized delivery of higher levels of care for high-risk patients.