An evaluation of standards for the hospital care of premature infants.

Abstract

The hypothesis that conformity with recommended standards of hospital care for premature infants makes for higher neonatal survival rates was tested by rating a number of hospitals as to their conformity to such standards and comparing the ratings with observed neonatal mortality data. The ratings were based on direct observation of hospital practices at the beginning and at the end of the year of study and were themselves tested for reliability; they revealed a wide diversity in the quality of care given to premature infants and permitted the grouping of hospitals into high, middle, and low thirds. The hospitals in the high third tended to be larger, to have a higher percentage of nonwhite patients, and to be the recipients of patients referred from lower-ranking hospitals; nevertheless, the percentage of 28-day survivals for infants who weighed 2,500 Gm. (5.5 lb.) or less at birth was 85.6% for the high third as compared with 81.5% and 82.2% for the middle and low thirds. The difference in survival rates was most perceptible in the group of infants weighing from 1,001 to 1,500 Gm. (2.2 to 3.3 lb.) at birth. These data support the recommended standards as a whole insofar as survival is a criterion. The low survival rate of premature infants, even in hospitals conforming to standards, and the evidence that premature babies who survive have a higher than average incidence of handicaps show that increased emphasis and support should be given to methods of preventing or delaying premature birth.