Improved outcomes of extremely premature outborn infants: Effects of strategic changes in perinatal and retrieval services

Royal Hospital for Women, Sydney, New South Wales, Australia
PEDIATRICS (Impact Factor: 5.47). 12/2006; 118(5):2076-83. DOI: 10.1542/peds.2006-1540
Source: PubMed


The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia.
The intervention included additional, network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system, with preferential admission of retrieved infants (outborn infants) to perinatal centers instead of freestanding pediatric hospitals, from the middle of 1995. Population birth and NICU admission cohorts of infants of 23 to 28 weeks of gestation were studied. Outcomes of epoch 1 (1992 to the middle of 1995; 1778 births and 1100 NICU admissions) were compared with those of epoch 2 (1997-2002; 3099 births and 2100 NICU admissions), after an 18-month washout period.
There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants.
Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.

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Available from: Mohamed E Abdel-Latif
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    • "2. Neonatal Intensive Care Units' follow-up data collection, an ongoing statewide audit at 2–3 years of age, corrected for prematurity, of infants born less than 29 weeks' gestation. A full description of the NICUS and follow-up data and the NSW and ACT neonatal service organization and networking is available elsewhere [6] [7]. 2.2. "
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    • "Other studies have concluded that an important factor associated with outcome is the need for transport from the delivery hospital to a higher level NICU7891011121314. Indeed, it has been found in some studies that the rates of severe neonatal morbidities were lower in those premature infants born after maternal transport than in premature infants transported after birth[15,16]. Thus, both delivery hospital and transport have been implicated in impacting the outcomes of premature infants following neonatal intensive care. Nationwide Children's Hospital (NCH) is the only tertiary care NICU (Level IIIc) in Central Ohio, but does not provide a delivery service. "
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    ABSTRACT: Objective: The outcome of premature infants is negatively impacted by transport, and in Central Ohio every effort is made to transport the mother prior to preterm delivery. Our neonatal intensive care unit is an all referral unit, thus all babies are transported and the referral hospitals include those without neonatology coverage, and those with neonatology coverage. We tested the hypothesis that the outcomes of extremely premature infants (<27 weeks gestational age) admitted to our NICU would be better when the infant was referred from a hospital with neonatology coverage. Patients and methods: We collected data from 227 patients admitted from December, 2004 to August, 2008; 192 patients were from hospitals with neonatology coverage. Results: The survival rate was greater for those babies referred from hospitals with neonatology coverage than in those referred from hospitals without neonatology coverage (82% vs. 60%, p = 0.007), as was the combined outcome of survival without Grade 3/4 IVH (68% vs. 43%, p < 0.01). When limited to only those patients admitted at <3 days of life, survival was better for infants referred from hospitals with neonatology coverage than those referred from hospitals without it (77% vs. 63%; p < 0.05). Conclusion: These results suggest that for infants born at <27 weeks admitted to an all referral unit delivery in a hospital with neonatology coverage leads to better survival.
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