ObstetricsAssociation between level of delivery hospital and neonatal outcomes among South Carolina Medicaid recipients☆
Section snippets
Material and methods
After approval was obtained from the University of South Carolina’s institutional review board, we performed a retrospective cohort analysis to examine these relationships. The cohort consisted of infants with birth weights between 500 and 1499 g who were born between 1991 and 1995 to mothers who were South Carolina residents and received Medicaid for neonatal care of the infant. The exposure variable, level of hospital, was first categorized as level I, level II without 24-hour neonatology
Results
Table II presents the demographic characteristics of mothers and infants included in the neonatal mortality analysis according to level of delivery hospital.Characteristic Level I (n = 109) Level II (n = 325) Enhanced level II (n = 88) Level III (n = 2038) No. % No. % No. % No. % Maternal transfer* No 109 100.0 323 99.4 88 100.0 1536 75.4 Yes 0 0.0 2 0.6 0 0.0 502 24.6 Infant transfer* No 28 25.7 117 36.0 50 56.8 1533 75.2 Yes 81 74.3 208 64.0 38 43.2 505 24.8
Comment
In agreement with several recent studies we found higher neonatal mortality rates among VLBW infants born outside level III hospitals than among infants born in level III hospitals.6, 7, 8, 9, 10 A recent study of 62 neonatal intensive care units participating in the Vermont Oxford Network reported no difference in standardized neonatal mortality ratios according to annual neonatal intensive care unit volume.20 Those investigators may not have found an association between neonatal intensive
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Cited by (48)
Access to risk-appropriate hospital care and disparities in neonatal outcomes in racial/ethnic groups and rural–urban populations
2021, Seminars in PerinatologyCitation Excerpt :More recent studies support these older studies. In general, there was a 30 to 75% increase in mortality when infants with a birth weight under 1,500 grams were delivered at lower level or lower volume hospitals.9,10,12,17–36 A meta-analysis of the evidence published through 2010 summarized these results, showing increased odds of death for very low birth weight infants born outside of hospitals with a level 3 or level 4 NICU, an odds ratio of 1.62.
Alterations in fibrin formation and fibrinolysis in early onset-preeclampsia: Association with disease severity
2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :However, the commonly used criteria for severity (including hypertension and proteinuria) correlate poorly with maternal and fetal outcome [13]. Moreover, particularly in non-tertiary units, it is crucial that women with EOP are reliably and quickly identified to facilitate timely administration of steroids for fetal lung maturity, magnesium sulphate to prevent seizures and referral to specialized tertiary centres, as these measures can greatly reduce both maternal and fetal morbidity by facilitation of early intervention before severe complications have occurred [12,14–16]. As such, characterization of laboratory markers with differential expression in EOP and normal pregnancy is clinically relevant as this may uncover future biomarkers with diagnostic potential in this dangerous condition.
Role of plasma PlGF, PDGF-AA, ANG-1, ANG-2, and the ANG-1/ANG-2 ratio as predictors of preeclampsia in a cohort of pregnant women
2019, Pregnancy HypertensionCitation Excerpt :ROC curve analyses were also conducted to evaluate the predictive power of the right and left uterine artery pulsatility indices (RUAPI and LUAPI) (Graph 6 and 7, respectively) and the mean pulsatility index of the uterine arteries (right and left) (MPIUA) (Graph 8). The identification of biomarkers capable of predicting preeclampsia is critical, given it allows the stratification of high-risk pregnant women and their referral to appropriate treatment centers, thus reducing neonatal morbidity and maternal and fetal mortality [17–19]. In the present study, the pregnant women who developed preeclampsia exhibited higher systolic, diastolic, and mean arterial pressure at the first prenatal visit, where the mean gestational age was 23 weeks, that is, before developing the disease.
Perinatal legislative policies and health outcomes
2017, Seminars in PerinatologyCitation Excerpt :Selection bias and confounding was a particular problem in these older studies, with only four studies controlling for severity of illness.36,40,44,46 Studies using data from the period of deregionalization also support these findings, showing a 30–75% increase in mortality when infants with a birth weight under 1500 g are delivered at lower level or lower volume hospitals.29,31,36,46–61 There are a limited number of studies that find better outcomes when these deliveries occur in hospitals with higher volume NICUs.51,62–69
The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients
2012, American Journal of Obstetrics and GynecologyCell-free nucleic acids as potential markers for preeclampsia
2011, PlacentaCitation Excerpt :Furthermore, if these tests could provide useful indications as to which women are likely to develop early onset preeclampsia or a severe form of the disorder, this would allow an accurate risk categorization of women and would permit medical care providers to plan a more tailored course of action, e.g. a referral to a specialist centre. This single action alone decreases neonatal mortality by approximately 20% [2]. Currently, there is no single reliable parameter for the prediction of preeclampsia, and much attention has turned towards developing non-invasive testing methods, including ultrasound examination and the quantification of various blood-borne and urinary biomarkers.
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Reprint requests: Maureen Sanderson, PhD, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208.