Pregnant mothers out of the perinatal regionalization's reach.
BACKGROUND
Birth of very low birth weight (VLBW) infants outside subspecialty perinatal centers increases risk for death and major morbidities.


OBJECTIVE
The purpose of this study is to evaluate barriers to utilizing a regional perinatal center for the birth of VLBW infants to mothers not living in the immediate vicinity of the center.


METHODS
We conducted a retrospective cohort study of VLBW infants residing in the catchment area of a community level II, Specialty Neonatal Unit (SN) admitted to a Regional Subspecialty Neonatal Intensive Care Unit (RC) between January 1999 and December 31, 2004. Maternal demographics and prenatal care as well as outcomes were compared by place of birth.


RESULTS
Out of 98 VLBW infants admitted to the RC, 49 (50%) were delivered outside the RC (out-born) and 49 (50%) were born at the RC (in-born). There was no statistical difference in insurance coverage, race, gestational age, severity of illness or maternal demographic factors between out-born and in-born infants. Less than adequate prenatal care rather than distance of maternal residence from the RC was associated with birth outside the RC. Adjusting for prenatal care, distance of residence from the RC increased the risk for delivering outside the center in the subset of mothers insured by Medicaid.


CONCLUSIONS
Mothers of VLBW infants who received less than adequate prenatal care and did not live in the vicinity of a subspecialty center had an increased risk for delivery outside that center compared to those with adequate care. Appropriate place of birth for VLBW infants to low-income mothers may be influenced by the distance of their residence to an RC.
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI 48109, USA. mattar@umich.edu
M A
MA
Attar
K
K
Hanrahan
S W
SW
Lang
M R
MR
Gates
S L
SL
Bratton
D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006771:Hospitals, Maternity / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008484:Medicaid / Q000706:statistics & numerical data; D008824:Michigan; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014600:Utilization Review