The effect of birth hospital type on the outcome of very low birth weight infants.

To test the hypothesis that the likelihood of death or major morbidity is reduced for very low birth weight (VLBW; <1500 g) infants who are born at hospitals with subspecialty perinatal and neonatal care compared with other available birth sites. A population-based cohort study was conducted of all live births of 500 to 1499 g at the 19 hospitals in the greater Cincinnati region from September 1, 1995, through December 31, 1997 (N = 848). Primary outcome was the risk-adjusted, predischarge mortality or morbidity, including bronchopulmonary dysplasia, severe intracranial hemorrhage, severe retinopathy of prematurity, or necrotizing enterocolitis for VLBW infants who were born at subspecialty perinatal centers compared with those who were born at nonsubspecialty centers. The odds of death or major morbidity for VLBW infants who are born at nonsubspecialty perinatal centers is twice that of infants who are born at subspecialty centers despite controlling for demographic (odds ratio [OR]: 2.64; 95% confidence interval [CI]: 1.7-4.2) and practice characteristics (OR: 1.96; 95% CI: 1.2-3.2). The effect of birth hospital type on death or major morbidity was greater for infants of 1000 to 1499 g birth weight (OR: 3.42; 95% CI: 2.0-6.1) than for infants of 500 to 999 g birth weight (OR: 2.1; 95% CI: 1.0-4.8). The current study lends strong support to existing Academy of Pediatrics and American College of Obstetricians and Gynecologists recommendations that deliveries at <32 weeks' gestational age occur at subspecialty perinatal centers.