Abstract
Large preterm infants (born before 37 completed weeks of gestation and weighing >2250 grams) experience a neonatal mortality risk almost 4 times higher than do term infants in the same weight range. In an analysis of the effect of hospital level of birth op neonatal mortality, such large preterm infants were found to experience higher mortality if born outside of a tertiary care (Level 3) center. For all singleton infants in this weight-gestation category born in New York City over a 3 year period (N=23,257), the relative mortality risk for Level 1 births (compared to Level 3) was 1.72 (p<.01) and for Level 2 births 1.47 (p <.05). The excess mortality at Level 1 and Level 2 units was almost entirely due to a more than twofold higher death rate in black infants born in these units. Several potentially confounding socio-economic, demographic and biological variables entered into a logistic regression model could not account for the higher mortality rates in Level 1 and Level 2 units. Deaths in large preterm black infants born at Level 1 hospitals were less likely to occur in a receiving tertiary care center than were deaths in low birthweight infants, or deaths in term normal weight infants, suggesting that the need for special care of large preterm infants is underestimated in hospitals without newborn intensive care units.
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Paneth, N., Wallensteln, S., Klely, J. et al. 571 MEDICAL CARE AND THE LARGE PREMATURE INFANT. Pediatr Res 19, 206 (1985). https://doi.org/10.1203/00006450-198504000-00601
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DOI: https://doi.org/10.1203/00006450-198504000-00601