Being Born at the Right Place: Neonatal Levels of Care

Being Born at the Right Place: Neonatal Levels of Care

By Capt. Wanda Barfield, MD, MPH*
Team Leader Maternal, Child Health Epidemiology Team
Centers for Disease Control and Prevention, Atlanta, GA 

Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States infant mortality rate from 2000 to 2005, therefore providing appropriate care for these vulnerable infants is vital. Perinatal regionalized systems, including obstetrical transport and appropriate referral to neonatal intensive care, have been an important mechanism for improving outcomes for preterm and medically complex infants. However, regionalized systems do not exist in all states and regulatory language defining levels of neonatal care vary significantly. The MCHB national performance measure #17, which measures the percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates, has been below the goal of 90 percent for many states. Recent increases in infant mortality may, in part, be an unintended consequence of deficiencies in regional organization of perinatal care. 

Review of the state data revealed that no consensus exists for definitions of neonatal levels of care. States varied in infant gestational age and birth weight criteria, healthcare provider criteria, transport responsibilities, and, enforcement of standards used. The 2003 revised birth certificate provided new data on neonatal intensive care unit admission as well as use of effective therapies, such as antenatal steroids and surfactant. Only 10 states reported reaching the national goal of 90 percent of very low birth weight infants delivered in appropriate facilities with all states ranging from 33 percent to 92 percent. 

Moving forward, state health departments have an opportunity to participate in defining newborn levels of hospital care and lead in the development of methods to monitor the quality of maternal, perinatal and newborn care through policy, data collection and analysis. As we move forward to define ways to prevent preterm birth, we must not lose ground in providing appropriate care to mothers and infants at high risk for adverse perinatal outcomes. 

References

American Academy of Pediatrics. Levels of neonatal care. Pediatrics 2004;114:1341-1347.

Blackmon L, Barfield WD, Stark AR. Hospital Neonatal Services in the United States: Variation in Definitions, Criteria, and Regulatory Status, 2008. J Perinatol. (in press)

Committee on Perinatal Health. Toward improving the outcome of pregnancy: recommendations for the regional development of maternal and perinatal health services. White Plains, NY: March of Dimes National Foundation; 1976.

MacDorman MF, Mathews TJ. Recent Trends in Infant Mortality in the United States. NCHS data brief, no 9. Hyattsville, MD: National Center for Health Statistics. 2008.

Menacker F, Martin JA. Expanded health data from the new birth certificate, 2005. National vital statitics reports; vol 56 no 13. Hyattsville, MD: National Center for Health Statistics, 2008.

U. S. Department of Health and Human Services, Health Resources and Service Administration, Maternal and Child Health Bureau. Special Reports: comparison of selected performance measures for the nine most populous states. National performance measure # 17. Found at: https://perfdata.hrsa.gov/mchb/mchreports/Search/core/corsch02p_special1_result1.asp?Measure=17&SortOrder=Desc Last accessed Oct 17, 2008.

 

*The findings and conclusions in this article are those of the author and do not necessarily represent the official position of CDC.