Very
Low Birth Weight Infants:
Are they being delivered at facilities appropriate for their
care?
The rates of prematurity are increasing in Utah as in the
U.S. as a whole. The preterm birth rate in Utah in 2006
was 9.9% of all live births, representing 5,309 infants.
A small proportion of premature infants are born weighing
less than 1500 grams and are considered very low birth weight
(VLBW); in Utah 1.05% of infants born in 2006 were VLBW
representing 563 infants. These are the most vulnerable
among premature infants and their survival and long term
functioning depends on expert perinatal and neonatal care
received at health facilities appropriately equipped to
deliver high risk infants. Most studies that link neonatal
outcomes with levels of perinatal care indicate that morbidity
and mortality for VLBW infant are improved when delivery
occurs at the appropriate level facility, even after adjustments
for severity of illness.[1]
The
American Academy of Pediatrics (AAP) published Guidelines
in 2004 that classify health facilities on the basis of
functional capabilities for neonatal intensive care. These
classifications are outlined in Table 1.
Table
1
| Classification
|
Description |
| Level
1 |
Provide
a basic level of newborn care to infants at low risk |
| Level
2 |
Provide
care to infants who are moderately ill with problems
that are expected to resolve rapidly. In general, care
in this setting should be limited to newborns > 32
wks. weighing > 1500 gms. |
| Level
3 |
Provide
care to preterm, VLBW infants and have continuously
available personnel and equipment to provide life support
for as long as needed. |
The
Healthy People 2010 objective is for 90% of VLBW infants
to be delivered at facilities appropriate for high-risk
deliveries (Level 3). In Utah during 2006 approximately
84% of VLBW infants were delivered at Level 3 facilities.
While a small proportion of VLBW deliveries will continue
to take place at Level 1 or 2 facilities due to an inability
to safely transport laboring mothers prior to a precipitous
delivery or due to known fetal complications precluding
survival, it appears that there is room for improvement
in assuring that these fragile newborns are delivered at
facilities best equipped to assure their survival and well
being. Adherence to the AAP Guidelines will assure provision
of an increasingly complex quality of care for these newborns.
[2]
1. Blackmon, L., The role of the hospital of birth on survival
of extremely low birth weight, extremely preterm infants.
Neo Reviews, 2003. 4: p. 147-157.
2. AAP, Levels of Neonatal Care. Pediatrics, 2004. 114:
p. 1341-1347.
Click
here to read the full AAP statement on Levels of Neonatal
Care
