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Obstetrical volume and early neonatal mortality in preterm infants

  • Perinatal Epidemiology
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Objective Regionalised perinatal care with antenatal transfer of high risk pregnancies to Level III centres is beneficial. However, levels of care are usually not linked to caseload requirements, which remain a point for discussion. We aimed to investigate the impact of annual delivery volume on early neonatal mortality among very preterm births. Methods All neonates with gestational age 24–30 weeks, born 1991–1999 in Lower Saxony were included into this population-based cohort study (n = 5,083). Large units were defined as caring for more than 1,000 deliveries/year, large NICUs as those with at least 36 annual very low birthweight (<1,500 g, VLBW) admissions. Main outcome criterion was mortality until day 7. Adjusted Odds Ratios (adj. OR) and 95% confidence intervals (CI) were calculated based on generalised estimating equation models, accounting for correlation of individuals within units. Results Within the first week of life, 20.6% of all neonates deceased; 10.2% were stillbirths, 3.7% died in the delivery unit, and 6.7% in the NICU. The crude OR for early neonatal mortality after having been delivered in a small delivery unit (excluding stillbirths) was 1.36 (95%CI 1.04–1.78; adj. OR 1.16 (0.82–1.63)). It increased to 1.96 (1.54–2.48; adj. OR 1.21 (0.86–1.70)) after the inclusion of stillbirths. Conclusion This study has shown a slight, but non-significant association between obstetrical volume and early neonatal mortality. In future studies the impact of caseload on outcome may become more evident when referring to high-risk patients instead of to the overall number of deliveries.

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Abbreviations

Adj.:

Adjusted

AGA:

Appropriate weight for gestational age

CI:

Confidence interval

GA:

Gestational age

GEE:

General estimating equation

LGA:

Large for gestational age

MV:

Missing value

NICU:

Neonatal intensive care unit

OR:

Odds ratio

RDS:

Respiratory distress syndrome

SGA:

Small for gestational age

VLBW:

Very low birthweight (<1,500 g)

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Authors and Affiliations

  1. Department of Epidemiology, Public Medicine and Healthcare Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, OE 5410, 30625, Hannover, Germany

    Dorothee B. Bartels

  2. Center for Quality and Management in Health Care, Hannover, Germany

    Paul Wenzlaff

  3. Department of Neonatology, University of Tübingen, Tubingen, Germany

    Christian F. Poets

Authors
  1. Dorothee B. Bartels
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  2. Paul Wenzlaff
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  3. Christian F. Poets
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Correspondence to Dorothee B. Bartels.

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Bartels, D.B., Wenzlaff, P. & Poets, C.F. Obstetrical volume and early neonatal mortality in preterm infants. Eur J Epidemiol 22, 791–798 (2007). https://doi.org/10.1007/s10654-007-9182-6

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  • DOI: https://doi.org/10.1007/s10654-007-9182-6

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