Hospital quality may affect infant morbidity

By Helen Albert, Senior medwireNews Reporter

Birth in or postnatal transfer to hospitals with a lower level of resources and facilities may negatively impact the health of very preterm infants, show research findings.

The investigators, led by Liisi Rautava from Turku University Hospital in Finland, found that rates of asthma and retinopathy were significantly higher in very preterm infants who were born in level III, but transferred to level II hospitals (group II/III) at the age of 5 years than in those born and cared for in level III hospitals (group III).

Epilepsy and hyperkinetic disorders were also higher in children born and cared for in level II hospitals (group II; preterm baby unit but minimal access to more complex/specialized equipment or resources) than in level III hospitals.

The results of this study add to those from previous research showing that birth in a level III hospital, as determined by having access to the most comprehensive care facilities for very premature and low-birthweight infants, significantly reduces the mortality of very premature babies compared with birth in lower grade hospitals.

As reported in the Archives of Pediatric and Adolescent Medicine, Rautava and colleagues followed up all surviving 5-year-old children (n=2168) enrolled in the Performance, Effectiveness, and Cost of Treatment Episodes (PERFECT) Preterm Infant Study. A cohort of 238,857 similarly aged full-term (37-42 weeks) children who were born between January 2000 and December 2004 were also included in the study for comparison purposes.

The researchers compared very preterm children in groups III, II/III, and II to assess whether any comorbidities (diagnosed after first home discharge) were overexpressed.

Rautava and co-authors found that children in group II/III had a significant 2.43-fold increased incidence of retinal disorders and a 1.41-fold increased risk for asthma compared with children in group III. They did have a significant 25% lower viral infection rate than group III children, however.

Children in group II had significant 2.71- and 2.19-fold increased risks for epilepsy and hyperkinetic disorders when compared with group III children.

No other comorbidity increases were observed, but the researchers say that the increased level of retinal disorders and asthma in group II/III children "calls for analysis of the differences in treatment practices between hospital levels."

They add that this finding, as well as the increased level of epilepsy and hyperkinetic disorders seen in group II versus group III children "warrants further evaluation of treatment policies, such as oxygen use and nutritional care, in level II hospitals in Finland."

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