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Low Weight Newborns at Greater Risk in Community Hospitals

A research team at Stanford University School of Medicine and the Veterans Affairs Palo Alto Health Care System states that more than 20 percent of low weight new- born deaths between 1991 and 2000 in California, could have been prevented.

The babies would have survived if they had been born in different hospitals. Risky deliveries should be referred to highly experienced regional medical centers. This would afford the best chance of survival for newborns, who weigh less than 3.3 pounds.

Although the findings show that such a proposal is feasible, it flies in the face of a growing trend of decentralization in which community hospitals with lower-level neonatal intensive care units are shouldering an increasing number of complex patients.

"We can do better," said Ciaran Phibbs, PhD, a health economist at the Health Economics Resource Center at the Veterans Affairs Palo Alto Health Care System and an associate professor of pediatrics at Stanford's School of Medicine. "Although being born in a place with a mid-level neonatal intensive care unit is better than a place with no neonatal ICU at all, we found that these extremely tiny newborns were significantly more likely to survive in hospitals that cared for at least 100 such infants each year."

Phibbs is the lead author of the study, which will be published in the May 24 issue of the New England Journal of Medicine. The risks are real. Although very-low-birth-weight infants account for between 1 and 2 percent of births each year in California, they make up 51 percent of infant deaths.

Neonatal ICUs are classified according to the kind of care they can provide. The neonatal ICU at Lucile Packard Children's Hospital at Stanford is a level-3D center - the highest level reserved for hospitals that perform on-site cardiac surgery and a type of heart/lung bypass for newborns.

Packard Children's cares from more than 100 very-low-birth-weight
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