level of care; Neonatal morbidity; low-risk nulliparas
Abstract :
[en] Objective
To analyze the risk of admission to neonatal care for newborns of low-risk nullipara and its variation with level of care of the maternity unit.
Study design
The sample included infants born to low-risk nulliparas from the PREMODA study of 138 French maternity units (n = 3652). Medical records of children admitted to neonatal care were reviewed to determine the reasons for admission and the severity of morbidity. The risk factors associated with admission to neonatal care, including maternal, infant and delivery unit characteristics, were studied by univariable analysis, followed by a multivariable analysis using a multilevel logistic model.
Results
The newborns of 3.5% (n = 129) of the nulliparous mothers at low risk were admitted to neonatal care at birth. The two principal reasons were infections (57%) and respiratory diseases (19%). Babies born in level 2 maternity units were twice as likely to be admitted to neonatal care as those born in level 1 units (ORa = 2.0 [1.1–3.7]) and those born in level 3 units, 1.5 times more often, although this was not statistically significant (ORa = 1.5 [0.8–2.8]). Babies admitted to neonatal care after delivery in level 1 had more severe morbidity (n = 4, 26.7%) than those admitted from level 2 (n = 4, 5.7%) or level 3 (n = 3, 6.8%) facilities (p = 0.046).
Conclusion
In low-risk populations, the level of care could have an influence on the decision to admit babies to neonatal care at birth. These findings add to the on-going debate about the optimal organization of care for women at low obstetrical risk.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Le Ray, C.
Zeitlin, J.
Jarreau, P. H.
Bréart, G.
Goffinet, F.
Premoda Study Group
Foidart, Jean-Michel ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie - Obstétrique - Labo de biologie des tumeurs et du développement
Language :
English
Title :
The influence of level of care on admission to neonatal care for babies of low-risk nullipara
Publication date :
2009
Journal title :
European Journal of Obstetrics and Gynecology and Reproductive Biology
AUDIPOG. La santé périnatale en 2002-2003. Evaluation des pratiques médicales. http://audipog.inserm.fr/pdf/cahier_2002_2003.pdf.
Zeitlin J., Papiernik E., and Breart G. Regionalization of perinatal care in Europe. Semin Neonatol 9 2 (2004) 99-110
Ministère de l'emploi et de la solidarité. Journal Officiel de la République Française. Décret n°98-899 et n° 98-9000 du 9 octobre 1998.
Combier E., Zeitlin J., de Courcel N., et al. Choosing where to deliver: decision criteria among women with low-risk pregnancies in France. Soc Sci Med 58 11 (2004) 2279-2289
Le Ray C., Carayol M., Zeitlin J., Breart G., and Goffinet F. Level of perinatal care of the maternity unit and rate of cesarean in low-risk nulliparas. Obstet Gynecol 107 6 (2006) 1269-1277
Hemminki E., and Gissler M. Variation in obstetric care within and between hospital levels in Finland. Br J Obstet Gynaecol 101 10 (1994) 851-857
Hemminki E., Gissler M., and Saarikoski H. Variation in referring newborns to special care in Finland. Scand J Public Health 27 2 (1999) 124-127
Goffinet F., Carayol M., Foidart J.M., et al. Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium. Am J Obstet Gynecol 194 4 (2006) 1002-1011
Perinatal care: the government plan 1995-2000. Soins Gynecol Obstet Pueric Pediatr 1994;156:43-5.
Blondel B., Supernant K., Du Mazaubrun C., and Breart G. Trends in perinatal health in France between 1995 and 2003: results from the National Perinatal Surveys. J Gynecol Obstet Biol Reprod (Paris) 35 4 (2006) 373-387
Hannah M.E., Hannah W.J., Hellmann J., et al. Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. N Engl J Med 326 24 (1992) 1587-1592
Rabe-Hesketh S, Skrondal A, Pickles A. Gllamm Manual. U.C. Berkeley Division of Biostatistics Working Paper Series; 2004.
Gray J.E., McCormick M.C., Richardson D.K., and Ringer S. Normal birth weight intensive care unit survivors: outcome assessment. Pediatrics 97 6 Pt 1 (1996) 832-838
Lau T.K., Chung K.H., Haines C.J., and Chang A.M. Fetal sex as a risk factor for fetal distress leading to abdominal delivery. Aust N Z J Obstet Gynaecol 36 2 (1996) 146-149
Lieberman E., Lang J.M., Cohen A.P., Frigoletto Jr. F.D., Acker D., and Rao R. The association of fetal sex with the rate of cesarean section. Am J Obstet Gynecol 176 3 (1997) 667-671
Cleary R., Beard R.W., Chapple J., et al. The standard primipara as a basis for inter-unit comparisons of maternity care. Br J Obstet Gynaecol 103 3 (1996) 223-229
Read A.W., Prendiville W.J., Dawes V.P., and Stanley F.J. Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia. Am J Public Health 84 1 (1994) 37-42
Gouyon-Cornet B., Breart G., Chabernaud J.L., et al. Assessment by a national survey of needs for NICU and intermediate NICU in France. Arch Pediatr 10 11 (2003) 969-978
Merlo J., Gerdtham U.G., Eckerlund I., et al. Hospital level of care and neonatal mortality in low- and high-risk deliveries: reassessing the question in Sweden by multilevel analysis. Med Care 43 11 (2005) 1092-1100
Albers L.L., and Savitz D.A. Hospital setting and fetal death during labor among women at low risk. Am J Obstet Gynecol 164 3 (1991) 868-873
Heller G., Richardson D.K., Schnell R., Misselwitz B., Kunzel W., and Schmidt S. Are we regionalized enough? Early-neonatal deaths in low-risk births by the size of delivery units in Hesse, Germany 1990-1999. Int J Epidemiol 31 5 (2002) 1061-1068
Moster D., Lie R.T., and Markestad T. Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units. BJOG 108 9 (2001) 904-909
Berg C.J., Druschel C.M., McCarthy B.J., LaVoie M., and Floyd R.L. Neonatal mortality in normal birth weight babies: does the level of hospital care make a difference?. Am J Obstet Gynecol 161 1 (1989) 86-91
Nystrom K., and Axelsson K. Mothers' experience of being separated from their newborns. J Obstet Gynecol Neonatal Nurs 31 3 (2002) 275-282
Health Council of the Netherlands. Perinatal Intensive Care. The Hague; 2000.
Parmanum J., Field D., Rennie J., and Steer P. National census of availability of neonatal intensive care. British Association for Perinatal Medicine. BMJ 321 7263 (2000) 727-729