Fate of premature babies may be decided by which hospital they are born in

According to researchers in the U.S. premature babies have a better chance of surviving if they are cared for at specialist centers rather than at small hospitals.

It seems that over 1,000 very small babies in California died from 1991 to 2000 possibly because they were born in hospitals which lacked the expertise to deal with the tiniest premature infants.

The researchers say more than 20 percent of the tiniest babies who died probably could have been saved if they had been born in a highly experienced regional medical center.

They suggest that the trend towards smaller neonatal intensive care units (NICUs) may be contributing to the deaths of the smallest newborns.

In the new study by Stanford University School of Medicine the cases of 48,237 very-low-birth-weight infants born in California hospitals between 1991 and 2000 were examined and it was found that babies born before their due date were at a greater risk of dying if they were treated at hospitals not equipped with all the facilities required for their care.

The babies all weighed between 500 grams and 1,500 grams and the researchers found that the babies were more likely to survive if they were born at hospitals equipped with the latest neonatal units with all the advanced facilities needed to care for them.

Lead author Ciaran Phibbs, an associate professor of pediatrics at Stanford University School of Medicine says in the year 2000, 175 California babies died because they were born in hospitals that did not have enough experience with very-low-birth-weight infants.

Dr. Phibbs says in most states, most very-low-birth-weight infants are not being born where they should be and mothers with troublesome pregnancies, threatened with a very early gestation, should be directed to a specialized hospital.

The researchers say the answer would be to build large regionalized centers that specialize in such care and they suggest that smaller hospitals should pool their resources so if there was a need they could quickly transfer a baby between their hospitals.

It is estimated that around 12.5 percent of the babies born in the United States are defined as premature as they are born before 37 weeks of gestation, while about 1 percent are born before 32 weeks and require intensive care for survival.

The research is published in the May 24 issue of the New England Journal of Medicine.