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Morbidity and mortality of infants born before arrival at the hospital
1Department of Pediatrics, District of Columbia General Hospital, Washington, DC, USA.
Insights
Infants born before hospital arrival (out-born infants) face significantly higher risks. These newborns experienced increased intensive care needs and an 11-fold rise in mortality compared to in-hospital births.
Area of Science:
- Perinatal Medicine
- Neonatal Outcomes
- Public Health
Background:
- A notable number of infants are born outside a hospital setting (out-born).
- These out-born infants often experience adverse health outcomes.
- This study investigates the prevalence and outcomes of out-born infants compared to in-hospital deliveries.
Purpose of the Study:
- To determine the prevalence of out-born infants.
- To compare the outcomes of out-born infants with those born in the hospital.
- To identify risk factors associated with out-born deliveries.
Main Methods:
- Retrospective review of medical records for infants born between July 1988 and June 1992.
- Comparison of out-born infants (born before hospital arrival) with in-born infants.
- Statistical analysis using Fisher's Exact Test and chi-square test.
Main Results:
- Out-born infants constituted 1.8% of total deliveries (151 infants).
- Significant differences observed in out-born vs. in-born infants: illicit drug exposure (35% vs. 21%), low birth weight (39% vs. 16%).
- Out-born infants showed higher intensive care unit admissions (29% vs. 15%) and neonatal deaths (80 vs. 7 per 1,000 live births).
Conclusions:
- Out-born infants face a twofold increase in morbidity and an 11-fold increase in mortality.
- Despite representing less than 2% of deliveries, out-born infants accounted for 17% of total neonatal mortality.
- Urgent interventions are needed to improve outcomes for infants born outside the hospital.
Abstract:
Recently, a number of infants have been born at home, in an ambulance, car, etc., before arrival at the District of Columbia General Hospital. Many of these infants had poor outcome. To evaluate the prevalence and outcome of these infants, we reviewed medical records of all infants born before arrival at the hospital (out-born infants) and compared them with in-hospital deliveries from July 1988 to June 1992. Data were analyzed using Fisher's Exact Test and chi-square test. There were 151 (1.8%) out-born infants and 8,169 (98.2%) in-born infants during this 4-year period. Infants in both groups were predominantly black (85%). The following were significant differences (P < 0.001) between out-born and in-hospital deliveries, respectively: illicit drug exposure 35% vs 21%; low-birth-weight (< 2,500 g) infants 39% vs 16%; intensive care unit admissions 29% vs 15%; and neonatal deaths per 1,000 live births 80 vs 7. We conclude that there is a twofold increase in the morbidity (required intensive care) and an 11-fold increase in the mortality among out-born infants compared with infants delivered in-hospital. Even though out-born infants were < 2% of the total deliveries, they accounted for 17% of total neonatal mortality.