Pregnant women facing very early preterm delivery should be transferred to a level III hospital as early as practical, according to the findings of a new study that indicates it may help reduce the risk of infant deaths and complications.
In findings published this week in the medical journal JAMA Pediatrics, researchers from Northwestern Medicine in Chicago indicate that giving birth to a preterm baby at a hospital that is not rated level III for neonatal car may increase the risk of infant mortality. However, initiating a transfer early before delivery can save the infant’s life.
Researchers conducted a population based cross-sectional study including 4,800 infants born very preterm at Illinois perinatal-network hospitals between January 2015 and December 2016. Patients were followed up for 28 days after birth.
Among the 4,800 patients, nearly 70% of infants were born at level III hospitals after their mother was admitted into that hospital.
Another 14% were born at level III hospitals after being transferred from another hospital directly before delivery, and 17% of infants were born at non-level III hospitals.
Death rates for the very preterm infants born at level III hospitals was 12%. Death rates for infants born at level III hospitals after being transferred was 10%. However, death rates for infants born at non-level III hospitals was 17%.
While mortality rates between infants whose mothers were treated at level III hospitals and infants who were born at level III hospitals after their mothers were transferred were nearly the same, death rates for infants born at non-level III hospitals were much higher.
Level III hospitals provide care to high-risk patients, including high-risk mothers and newborns, such as infants born very preterm or women at risk of preeclampsia, in addition to the normal care provided to the typical patient. Level III hospitals also operate neonatal intensive care units (NICU) and can receive transfers from other hospitals.
An editorial accompanying the study highlighted the changes made to perinatal care in the late 1970s, focusing on regionalized care and the implementation of tiered hospital care. However, despite the implementation of specialized care with NICUs, smaller NICU’s may not be able to offer the same resources as larger units which can lead to poorer outcomes.
“For women with pregnancies requiring very preterm deliveries, receiving care at the right hospital with the right resources can be a matter of survival or normal development for their children,” wrote the editorial authors.
The researchers determined focusing on prenatal transfers early before delivery can increase an infant’s likelihood of surviving beyond birth. Failing to initiate early transfers to level III hospitals for very preterm infants can increase the risk of death.