Poster session III
464: Opportunities for maternal transport of pregnancies at risk for delivery of VLBW infants – results from the california maternal quality care collaborative

https://doi.org/10.1016/j.ajog.2014.10.510Get rights and content

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Objective

Neonatal morbidity and mortality is higher among transported very low birth weight (VLBW, <1500 grams) infants when compared to antepartum maternal transport and delivery in appropriate level III hospitals. The national Healthy People 2020 campaign set a goal reducing VLBW births at non-Level III centers to below 16.3%. We assessed the frequency of VLBW births at non-Level III hospitals in California and identified opportunities for improvement in maternal transport prior to delivery of at risk

Study Design

Retrospective cohort study using de-identified, linked birth certificate and discharge diagnosis data from the All-California, Rapid-Cycle, Maternal/Infant Database from the California Maternal Quality Care Collaborative (CMQCC) for the years 2008-2010. Study population included mother/infant pairs of either singleton or the first-born infant of multiple gestations, between 22 0/7 and 42 6/7 weeks, with BW 400-1500g, and maternal admission on or before infant date of birth.

Results

Of 1,508,143 births in the study population 13,919 were VLBW births. 14.9% of VLBW births occurred in non-Level III centers - 8.4% in Level I and 6.5% in Level II centers (Table). The median % of VLBW births at Level I hospitals was 0.26% (range 0% - 4.65%) annually, while the median % at Level II hospitals was 0.47% (range 0% -1.57%) annually. When analyzing the interval between maternal admission and delivery, antepartum length of stay >24 hours occurred in 14% and 26.9% of VLBW births in

Conclusion

Nearly 15% of VLBW infants in California were born at non-Level III centers, meeting the Healthy People 2020 goal. However, further improvement may be possible, given the 24 hour window of opportunity for maternal transport to a Level III center for a significant number of patients. Improving maternal transport of at risk pregnancies may reduce the number of VLBW infants delivering at suboptimal sites.

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