Birth at hospitals with co-located paediatric units for infants with correctable birth defects.
OBJECTIVE
To determine the percentage of liveborn infants with selected antenatally identifiable and correctable birth defects who were delivered at hospitals with co-located paediatric surgical units (co-located hospitals). Additionally, to determine the survival rates for these infants.


METHODS
Data were from linked New South Wales hospital discharge records from 2001 to 2004. Livebirths with one of the selected defects were included if they underwent an appropriate surgical repair, or died during the first year of life. Infants with multiple lethal birth defects were excluded. Deliveries at co-located hospitals were identified, but no data on antenatal diagnosis were available.


RESULTS
The study identified 287 eligible livebirths with the selected defects. The highest rates of delivery at co-located hospitals were for gastroschisis (88%), exomphalos (71%), spina bifida (63%) and diaphragmatic hernia (61%), and the lowest for transposition of the great arteries (43%) and oesophageal atresia (40%). Mothers resident outside of metropolitan areas, where the co-located hospitals are located, had a similar rate of delivery at co-located hospitals as metropolitan women. For the non-metropolitan mothers of infants with a birth defect, this represented a 30-fold increase over the baseline delivery rate of 1.8%. Post-surgery survival rates were 87% or higher. Overall survival rates were > or = 86% except for infants with a diaphragmatic hernia.


CONCLUSIONS
Delivery rates at co-located hospitals were high for mothers of infants with these correctable birth defects. Regionalised health care appears to work well for these pregnancies, as women living outside metropolitan areas had a similar rate of delivery at co-located hospitals to that of urban women.
Algert
Charles S
CS
Perinatal Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
Bowen
Jennifer R
JR
Hadfield
Ruth M
RM
Olive
Emily C
EC
Morris
Jonathan M
JM
Roberts
Christine L
CL
D000013:Congenital Abnormalities / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D005260:Female; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D009517:New South Wales / Q000453:epidemiology; D009725:Nurseries, Hospital; D010360:Patient Transfer; D011247:Pregnancy; D011296:Prenatal Diagnosis; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population