The impact of level of neonatal care provision on outcomes for preterm babies born between 27 and 31 weeks of gestation, or with a birth weight between 1000 and 1500 g: a review of the literature

Abstract

ObjectiveThere is evidence that birth and care in a maternity service associated with a neonatal intensive care unit (NICU) is associated with improved survival in preterm babies born at <27 weeks of gestation. We conducted a systematic review to address whether similar gains manifested in babies born between 27+0 and 31+6 weeks (hereafter 27 and 31 weeks) of gestation, or in those with a birth weight between 1000 and 1500 g.MethodsWe searched Embase, Medline and CINAHL databases for studies comparing outcomes for babies born between 27 and 31 weeks or between 1000 and 1500 g birth weight, based on designation of the neonatal unit where the baby was born or subsequently cared for (NICU vs non-NICU setting). A modified QUIPS (QUality In Prognostic Studies) tool was used to assess quality.ResultsNine studies compared outcomes for babies born between 27 and 31 weeks of gestation and 11 studies compared outcomes for babies born between 1000 and 1500 g birth weight. Heterogeneity in comparator groups, birth locations, gestational age ranges, timescale for mortality reporting, and description of morbidities facilitated a narrative review as opposed to a meta-analysis.ConclusionDue to paucity of evidence, significant heterogeneity and potential for bias, we were not able to answer our question—does place of birth or care affect outcomes for babies born between 27 and 31 weeks? This supports the need for large-scale research to investigate place of birth and care for babies born in this gestational age range.

Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants

“…This cohort study describes the novel finding of higher quality of care for MLP infants at type A and B NICUs after adjusting for patient characteristics. [8][9][10][11][12][13] Improved care quality for MLP infants at units with less complex surgical services appears to be primarily driven by improved scores in no extreme length of stay and change-in-weight z score. Consistent with research in a California cohort, extremely and very preterm care quality did not vary by unit type.…”

“…Infants born at 23 to 37 weeks' gestation have lower mortality at higher-level NICUs; however, the association of NICU level with MLP infant care quality and outcomes specifically was not studied. [8][9][10][11][12][13][14] The objective of this study was to evaluate the association of NICU type with the quality of care delivered to the MLP population who require NICU admission compared with extremely and very preterm infants. We hypothesized that type A and B NICUs may provide higher-quality care to the MLP population.…”

Performance Comparison of Infection Prediction Scores in a South African Neonatal Unit: A Retrospective Case-Control Study

“…The cohort they used was similar (≤33-week gestational age infants) with a predominance of Gram-negative organisms of 87%, however they only used infants born outside of the referral facility compared to our cohort that had only 10.3% born outside of the referral facility. A recent review on impact of place of birth on outcomes of babies born between 1,000 and 1,500 g failed to demonstrate any difference, however, the review did not include any LMIC units, and further research is needed on this topic ( 43 ). The Rosenberg score has the potential to be used to rule-in disease in our setting.…”

Recomendaciones de organización, diseño, características y funcionamiento de servicios o unidades de neonatología

“…Este tipo de centros corresponden a unidades de referencia para una o varias redes y concentran la atención de patologías médicas o quirúrgicas, que por su baja frecuencia de presentación deben ser atendidos por equipos especializados con gran experiencia y apoyados por equipamiento diagnóstico y terapéutico avanzados. La evidencia muestra mejores resultados obstétricos y neonatales cuando los centros concentran un mayor volumen de pacientes producto de la experiencia acumulada por los equipos clínicos [5][6][7][8][9][10][11][12][13][14][15][16][17] .…”

“…Por este motivo, todos los niveles de atención perinatales deben estar capacitados para diagnosticar situaciones de riesgo y dar la asistencia necesaria para estabilizar al recién nacido mientras se efectúa su traslado al centro de red con la capacidad resolutiva que corresponda 4,19 . Gracias a estas estrategias se han conseguido importantes mejorías en la sobrevida de estos pacientes complejos 9,17,18,[21][22] . Por otro lado, desde el punto de vista económico, el modelo de organización en redes de atención optimiza los recursos al hacer confluir recursos técnicos y humanos en centros que reciben los pacientes que los requieren.…”