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  • Title: 5-year morbidity among very preterm infants in relation to level of hospital care.
    Author: Rautava L, Eskelinen J, Häkkinen U, Lehtonen L, PERFECT Preterm Infant Study Group.
    Journal: JAMA Pediatr; 2013 Jan; 167(1):40-6. PubMed ID: 23128961.
    Abstract:
    OBJECTIVE: To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children. DESIGN: A cohort study. SETTING: Finland. PARTICIPANTS: All surviving 5-year-old children born very preterm (gestational age <32 weeks or birth weight ≤1500 g) born in level II or level III hospitals (n = 2168) and full-term (gestational age, 37-42 weeks) children (n = 238 857) born from January 1, 2000, through December 31, 2004. MAIN OUTCOME MEASURES: Diagnoses issued after the first discharge home and overrepresented in very preterm compared with full-term children. Diagnoses were analyzed between very preterm children (1) born and treated in level III hospitals (group III), (2) born in level III and transferred to lower-level hospitals (group III/II), and (3) born and treated in level II hospitals (group II). RESULTS: Group III/II children had an increased incidence of retinal disorders (odds ratio, 2.43 [95% CI, 1.66-3.56]) and asthma (1.41 [1.09-1.81]) but fewer viral infections (0.75 [0.59-0.95]) compared with group III infants. The risks for epilepsy (odds ratio, 2.71 [95% CI, 1.29-5.70]) and hyperkinetic disorders (2.19 [1.13-4.25]) were higher among group II than among group III children. No statistically significant differences between the groups for the 14 other diagnoses were found. CONCLUSIONS: The increased incidence of retinopathy and asthma among infants transferred from level III to lower-level hospitals calls for analysis of the differences in treatment practices between hospital levels.
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