The effect of birth in secondary- or tertiary-level hospitals in Finland on mortality in very preterm infants: a birth-register study.
OBJECTIVE
Our goal was to test the hypothesis that the level of the delivery hospital affects 1-year mortality of very preterm infants in Finland.


METHODS
This retrospective national medical birth-register study included 2291 very preterm infants (gestational age of < 32 weeks at birth or birth weight of < or = 1500 g) born in 14 level II (central) and 5 level III (university) hospitals in 2000-2003. The main outcome measures were adjusted total mortality (including stillbirths) and mortality of live-born infants until the age of 1 year.


RESULTS
Both the total 1-year mortality and the 1-year mortality of live-born infants were higher in level II hospitals compared with level III hospitals. Total mortality was higher in very preterm infants who were not born during office hours. In theory, delivery of all very preterm infants in level III instead of level II hospitals translates into an annual prevention of 69 of the 170 total deaths and prevention of 18 of the 45 deaths of live-born infants.


CONCLUSIONS
Resources in neonatal intensive care should be increased, especially during non-office hours, to have an equally distributed service through the 24-hour day. More efficient regionalization of very preterm deliveries may improve 1-year survival of very preterm infants in Finland.
Rautava
Liisi
L
Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland. liisi.rautava@utu.fi
Lehtonen
Liisa
L
Peltola
Mikko
M
Korvenranta
Emmi
E
Korvenranta
Heikki
H
Linna
Miika
M
Hallman
Mikko
M
Andersson
Sture
S
Gissler
Mika
M
Leipälä
Jaana
J
Tammela
Outi
O
Häkkinen
Unto
U
D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005387:Finland / Q000453:epidemiology; D005865:Gestational Age; D006761:Hospitals / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight