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High Level ICU Facilities Afford Greater Survival Chances for Small Infants

red with the newborn death rate among this group in hospitals with high-level and high-volume NICUs.

"Previous studies have established a link between high volume and high quality among NICUs, and this study offers further evidence of that relationship," said Carolyn M. Clancy, M.D., AHRQs Director. "It is becoming increasingly clear that some very low birth weight infants are not getting the care they need, and that we need to make sure that patients and clinicians know how important high-quality NICU care is."

The researchers were led by Ciaran Phibbs, Ph.D., Health Economist at the Health Economics Resource Center at the Veterans Affairs Palo Alto Health Care System and Associate Professor at the Department of Pediatrics at Stanford University.

The researchers analyzed data from more than 48,000 very low birth weight infants born in California hospitals from 1991 to 2000. They calculated newborn death rates by linking birth certificates, hospital discharge abstracts, and fetal and infant death certificates.

Despite the increased survival rate for very low birth weight infants in large, high-level NICUs, the researchers found that an increasing number of high-risk newborns are receiving care in low-volume, mid-level units.

In the past 20 years, a growing number of community hospitals have built NICUs, but most have been lower level facilities that see only a few very low birth weight infants.

"While lower-level NICUs are required to have formal relationships with high-level NICUs, the mere fact that they have such a relationship is no guarantee that the lower-level NICUs are going to get the same level of results as can be obtained at the large high volume NICUs," Dr. Phibbs said.

Dr. Phibbs and his colleagues determined that as much as 21 percent of very low birth weight infant deaths in California could have been avoided.

"The increasing number of NICU
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