Outcome of unattended out-of-hospital births in Harlem.
OBJECTIVE
To determine the maternal risk factors and infant outcome for unattended out-of-hospital deliveries brought to an inner-city public hospital.


METHODS
We compared 59 infants born alive out of hospital during 1989 with 151 randomly selected in-hospital live births, all with birth weight greater than 500 g.


RESULTS
History of cocaine use during pregnancy (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.68 to 10.5) and lack of Medicaid or other health insurance (OR, 2.15; 95% CI, 1.04 to 4.45) were independently associated with out-of-hospital delivery. Out-of-hospital delivery was associated with hypothermia (defined as admission axillary temperature < 35 degrees C; OR, 20.8; 95% CI, 4.81 to 89.9) and with hypoglycemia (defined as admission glucose reagent strip reading < 2.2 mmol/L [< 40 mg/dL]; OR, 4.41; 95% CI, 1.29 to 15.1) in separate analyses controlling for birth weight and other risk factors. Polycythemia (venous or arterial hematocrit > 0.65 at age > or = 6 hours) occurred in 14% (eight of 59) of out-of-hospital births. The increased neonatal mortality rate for infants born out of hospital (20.3 vs 7.3 per 1000 live births; OR, 2.82; 95% CI, 1.23 to 6.47) was due to an excess of infants weighing 500 to 999 g.


CONCLUSIONS
Unattended out-of-hospital births result in increased neonatal morbidity that may be partly preventable by simple interventions used routinely at inhospital deliveries.
Bateman
D A
DA
Department of Pediatrics, Harlem Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY.
O'Bryan
L
L
Nicholas
S W
SW
Heagarty
M C
MC
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006700:Home Childbirth / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007348:Insurance, Health; D007743:Labor, Obstetric; D008297:Male; D008484:Medicaid; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology