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Survival and place of treatment after premature delivery
1Department of Child Health, University of Leicester, Leicester Royal Infirmary.
Insights
Neonatal intensive care outcomes significantly improved for infants born at or before 28 weeks' gestation when treated at large, specialized centers compared to smaller units. Centralizing care for these vulnerable infants enhances survival rates.
Area of Science:
- Neonatal medicine
- Perinatal care
- Public health policy
Background:
- Premature infants, particularly those born at or before 28 weeks' gestation, have complex medical needs.
- The organization of neonatal services may impact short-term outcomes for high-risk infants.
Purpose of the Study:
- To compare the short-term outcomes (survival to discharge) of infants admitted to baby care units.
- To evaluate the impact of care setting size and specialization on survival rates for extremely preterm infants.
Main Methods:
- A one-year prospective study in the Trent region.
- Comparison of survival rates for infants ≤28 weeks' gestation treated at large specialized centers versus smaller units.
- Analysis of outcomes, considering elective transfers of critically ill infants.
Main Results:
- Infants ≤28 weeks' gestation treated at large centers (≥600 ventilator days/year) had significantly higher survival rates (52%) than those at smaller units (22%).
- Survival differences were not significant for more mature infants.
- Higher survival rates at large centers persisted despite the transfer of sickest infants from smaller to larger units.
Conclusions:
- Centralizing neonatal services for infants at or below 28 weeks' gestation is supported by improved survival rates.
- Specialized, high-volume neonatal centers provide better outcomes for extremely preterm infants.
- Healthcare policy should consider concentrating resources for high-risk neonatal care.
Abstract:
In a one year prospective study in the Trent region we examined the short term outcome (survival to discharge) of all infants who required admission to a baby care unit. Infants of less than or equal to 28 weeks' gestation who received all their perinatal care in one of five large centres (each providing more than 600 ventilator days/year) showed significantly better survival rates than infants electively treated throughout their entire course at one of the 12 smaller units (34 survivors from 65 infants (52%) compared with eight survivors from 37 infants (22%). These differences occurred despite the elective transfer of many of the sickest infants from the smaller units to the larger. Differences in survival between more mature infants were not significant. These results support the policy that there should be a more centralised neonatal service for those infants at or below 28 weeks' gestation.