More intensity of care may not be good for prematures

Abstract

It has been demonstrated repetitively that regionalization of care and maternal transfers improve outcomes for preterm infants. Outborns do not do as well when transferred to perinatal centers (obstetric plus neonatal care) as do inborns in those centers. Shah et al ask a more focused question: do outborn infants with gestational ages ≤32 weeks do better when transferred to perinatal centers or freestandard children's hospitals with neonatal intensive unit services? The characteristics of the services differ: the perinatal center cares primarily for preterm infants, while the units in children's hospitals specialize in the care of term infants with complex medical and surgical diseases. The preterms had a lower death rate, less nosocomial infection, and less bronchopulmonary dysplasia when cared for in a perinatal center. My preferred interpretation is that the care at the perinatal center will be less intensive in a less frenetic environment than at the children's hospital, which seems to translate to better outcomes for preterms. Many neonatologists who care primarily for preterms are using fewer catheters, fewer drugs, and fewer other interventions than in the past—behaviors that differ from care strategies of surgical units. This article may result in a rethinking of regional referral preferences for the very preterm infant. Improved outcomes of outborn preterm infants if admitted to perinatal centers versus freestanding pediatric hospitalsThe Journal of PediatricsVol. 146Issue 5PreviewTo examine whether admission hospital type (13 perinatal centers vs 4 freestanding pediatric hospitals) was associated with differences in risk and illness severity adjusted mortality and morbidity among outborn preterm infants. Full-Text PDF