Birth outside a level 3 hospital puts some infants at risk

A meta-analysis of 41 studies of neonatal or predischarge mortality among live-born infants weighing less than or equal to 1,500 g or those born at less than or equal to 32 weeks' gestation showed that these very low birth weight (VLBW) or very preterm (VPT) infants were at significantly higher risk of death if they were born in a facility other than a level 3 hospital.

According to a study conducted by the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention, VLBW infants born in hospitals less than level 3 had a 62% increase in the odds of neonatal or predischarge death than those born in level 3 hospitals (38% vs 23%). When the analysis was restricted to only higher-quality evidence (from 9 of the 41 studies), these odds were nearly as high: 60%.

In addition, VLBW infants (=1,000 g) born in less than level 3 hospitals had an estimated 80% increase in the odds of mortality compared with babies born at level 3 hospitals (59% vs 32%).

Lassell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA. 2010;304(9):992-1000.