The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants

doi:10.1016/S0029-7844(99)00528-1

Obstetrics & Gynecology

Volume 95, Issue 2, February 2000, Pages 291-295

https://doi.org/10.1016/S0029-7844(99)00528-1 Get rights and content

Abstract

Objective: To determine the incidence of grade III or IV intraventricular hemorrhage in very low birth weight (VLBW) infants born at level I hospitals and transported to one tertiary center compared with those delivered at the same level III facility.

Methods: We evaluated all newborns admitted to a large tertiary neonatal intensive care unit from June 1, 1992, through December 31, 1995. All live born infants with birth weights of 500–1200 g and at least 24 weeks’ gestation were included. Neonatal transports within 24 hours of delivery from 11 level I facilities were compared with those delivered at the same level III center with respect to grade III and IV intraventricular hemorrhage. Various antenatal and neonatal data were collected.

Results: Thirty-seven newborns (11%) experienced grade III or IV intraventricular hemorrhages among 329 who met study criteria. There were 27 cases (9%) in the 285 inborn neonates compared with 10 of 44 outborn cases (23%) (P < .02, 95% confidence interval 0.15, 0.87). The mean gestational age of the neonates with grade III or IV intraventricular hemorrhages was significantly lower in the inborn group, which further emphasizes the finding. No other study factors explained the difference.

Conclusion: We found a higher risk for grade III or IV intraventricular hemorrhage developing in VLBW infants born at level I hospitals and transported to the tertiary care center compared with those born at the level III facility. This data should be considered when analyzing the potential effects of perinatal deregionalization.

Section snippets

Materials and methods

Data from all neonates admitted to the newborn intensive care unit (NICU) at Miller Children’s Hospital in association with Long Beach Memorial Women’s Hospital were collected prospectively. The study period was June 1, 1992, through December 31, 1995, and the project was approved by the institutional review board.

Neonatal data collection included gestational age at delivery, birth weight, Apgar scores, mode of delivery, gender, use of rescue surfactant or indomethacin, and overall neonatal

Results

There were 37 cases (11%) of grade III or IV intraventricular hemorrhage in the 329 newborns who met study criteria: 27 of 285 delivered in the level III center (9%), and ten of 44 outborn neonates (23%), a statistically lower difference (P < .02, 95% confidence interval of 0.15, 0.87). Table 1 compares outborn and inborn groups for the total study population. The only significant difference was incidence of severe intraventricular hemorrhage.

Table 2 compares newborns who developed grade III or

Discussion

This study analyzed the incidence of severe intraventricular hemorrhage in VLBW neonates on the basis of birth location by level of institution. Neonatal care for both groups was in the same unit, so neonatal management was controlled. The main areas of difference were obstetric care (antenatal and intrapartum management), neonatal resuscitation, and effect of newborn transport. Our data found that the rate of grade III or IV intraventricular hemorrhage is lower in complicated pregnancies

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^☆: A portion of this study was funded through the Memorial Research Foundation of Long Beach Memorial Medical Center.

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Original ArticlesThe effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Fetal Drug Ther

J Pediatr

J Pediatr

Am J Obstet Gynecol

Toward improving the outcome of pregnancy. Recommendations for the regional development of perinatal health services

Obstet Gynecol

The regionalization of perinatal services. Summary of the evaluation of a national demonstration program

JAMA

Original Articles
The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants☆