Maternal and Infant Health Program Maternal and Infant Health Program

Phone:
  SLC area: (801) 538-9970

FAX:
  SLC area: (801) 538-9409

Mail:
  Maternal and Infant Health Program
  P.O. Box 142001
  Salt Lake City UT
  84112-2001




Very Low Birth Weight Infants:
Are they being delivered at facilities appropriate for their care?


The rates of prematurity are increasing in Utah as in the U.S. as a whole. The preterm birth rate in Utah in 2006 was 9.9% of all live births, representing 5,309 infants. A small proportion of premature infants are born weighing less than 1500 grams and are considered very low birth weight (VLBW); in Utah 1.05% of infants born in 2006 were VLBW representing 563 infants. These are the most vulnerable among premature infants and their survival and long term functioning depends on expert perinatal and neonatal care received at health facilities appropriately equipped to deliver high risk infants. Most studies that link neonatal outcomes with levels of perinatal care indicate that morbidity and mortality for VLBW infant are improved when delivery occurs at the appropriate level facility, even after adjustments for severity of illness.[1]

The American Academy of Pediatrics (AAP) published Guidelines in 2004 that classify health facilities on the basis of functional capabilities for neonatal intensive care. These classifications are outlined in Table 1.

Table 1

Classification Description
Level 1 Provide a basic level of newborn care to infants at low risk
Level 2 Provide care to infants who are moderately ill with problems that are expected to resolve rapidly. In general, care in this setting should be limited to newborns > 32 wks. weighing > 1500 gms.
Level 3 Provide care to preterm, VLBW infants and have continuously available personnel and equipment to provide life support for as long as needed.

The Healthy People 2010 objective is for 90% of VLBW infants to be delivered at facilities appropriate for high-risk deliveries (Level 3). In Utah during 2006 approximately 84% of VLBW infants were delivered at Level 3 facilities. While a small proportion of VLBW deliveries will continue to take place at Level 1 or 2 facilities due to an inability to safely transport laboring mothers prior to a precipitous delivery or due to known fetal complications precluding survival, it appears that there is room for improvement in assuring that these fragile newborns are delivered at facilities best equipped to assure their survival and well being. Adherence to the AAP Guidelines will assure provision of an increasingly complex quality of care for these newborns. [2]

1. Blackmon, L., The role of the hospital of birth on survival of extremely low birth weight, extremely preterm infants. Neo Reviews, 2003. 4: p. 147-157.
2. AAP, Levels of Neonatal Care. Pediatrics, 2004. 114: p. 1341-1347.

Click here to read the full AAP statement on Levels of Neonatal Care