1 / 37

Being Born at the Right Place

Being Born at the Right Place. Mary Boyd, MD, FAAP, President, WV Chapter American Academy of Pediatrics. Risk Appropriate Perinatal Care. Healthy People 2020 Goals. Case Study. Story of a birth of twins. National Performance Measure #17. Percent of VLBW (<1500 gram) infants

urvi
Télécharger la présentation

Being Born at the Right Place

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Being Born at the Right Place Mary Boyd, MD, FAAP, President, WV Chapter American Academy of Pediatrics

  2. Risk Appropriate Perinatal Care Healthy People 2020 Goals

  3. Case Study Story of a birth of twins

  4. National Performance Measure #17 Percent of VLBW (<1500 gram) infants delivered at Level III Perinatal Facilities (This has been measured for about 30 years)

  5. GoalPerformance Measure #17: 90% of VLBW Babies Should be born at Level III Perinatal Facilities

  6. Why 90%??!!

  7. VLBW Mortality is Lower for Infants Born in a Level III Centers Shown in multiple studies since 2004 including: • US • California, New York, Missouri, South Carolina, Missouri • Sweden – national registry • Finland – national registry • France - EPIPAGE

  8. Preterm Delivery, Level of Care, and Infant Death in Sweden: A Population-Based Study Stefan Johansson, MD*, ,Scott M. Montgomery, MD, PhD ,Anders Ekbom, MD, PhD ,Petra OtterbladOlausson, PhD||, Fredrik Granath, PhD ,Mikael Norman, MD, PhD*, Sven Cnattingius, MD, PhD * Women and Child HealthMedical Epidemiology and BiostatisticsClinical Epidemiology Unit, KarolinskaInstitutet|| National Board of Health and Welfare, Stockholm, Sweden Results. The rate of infant mortality increased from 5% amonginfants born at 31 weeks’ gestation to 56% among infantsborn at 24 weeks’ gestation. Compared with infants bornat university hospitals, the unadjusted odds ratio (OR) of infantdeath was 0.70 (95% confidence interval [CI]: 0.54–0.90)among infants delivered at general hospitals. However, afteradjustment, the OR of infant death shifted to 1.33 (95% CI:0.88–2.02) for preterm births at general hospitals. Thisshift was primarily due to different gestational age distributionsin regional and general hospitals. Among infants born at 24to 27 weeks’ gestation, infant mortality rates were 23%(87 deaths) in university hospitals and 32% (73 deaths) in generalhospitals. Pediatrics, 2004

  9. TABLE 4. Unadjusted Neonatal Outcomes by Location of Birth Pediatrics, 2004 Study done in Cincinnati; SPC=Specialty Perinatal Center

  10. Study done at George Washington University

  11. CDC Research Published 2010

  12. Perinatal Regionalization for Very Low-Birth-Weight and Very Preterm Infants—A Meta-analysis, Lasswell SM, Barfield WD, Rochat RR, Blackmon LR.  JAMA 2010; 304.9: 992-1000

  13. Results VLBW and very preterm infants born outside of a level III hospital are at an increased likelihood of neonatal death or death prior to discharge from the hospital. 

  14. The researchers identified 41 publications that met criteria to be included in the study. Analysis of the data of the VLBW studies (n = 37; 104,944 infants) indicated a 62 percent increase in odds of neonatal/predischarge death for infants born in non-level III hospitals compared with those born in level III hospitals (38 percent vs. 23 percent). When restricted to only higher-quality evidence (9 publications; 46,318 infants), a 60 percent increase in the odds of neonatal and/or predischarge mortality was estimated for VLBW infants born at non-level III hospitals (36 percent vs. 21 percent). Also, extremely low-birth-weight infants (1,000 grams [35 ounces] or less) born in non-level III hospitals had an estimated 80 percent increase in odds of neonatal and/or predischarge mortality compared with those born at level III hospitals (59 percent vs. 32 percent).

  15. “These recent scientific findings indicate that more work must be done to better understand the impact of risk-appropriate care on babies born too little or too soon.  Our regionalized systems must be systematically evaluated to determine effective care of neonates and prevent infant death”. Wanda Barfield, MD, MPH CDC/DRH Director and neonatologist

  16. How Measured? # <1500 gram infants born at Level III facilities Total # <1500 gram infants born

  17. Level III Perinatal Centers in WV CAMC - Women & Children's Cabell-Huntington Hospital WVU Children’s Hospital

  18. Locations of WV Birthing Facilities, 2010 HANCOCK Weirton General, Weirton, Ohio Valley Medical Center Wheeling Hospital BROOKE OHIO Monongalia General, Morgantown Reynolds Memorial, Glen Dale WVU Hospitals MARSHALL MONONGALIA Preston Memorial WETZEL MORGAN Fairmont General BERKELEY TYLER PRESTON City Hospital, Martinsburg MARION Camden Clark St. Joseph’s PLEASANTS MINERAL JEFFERSON TAYLOR HAMPSHIRE HARRISON Jefferson Memorial, Ranson DODDRIDGE GRANT RITCHIE WOOD BARBOUR TUCKER United Hospital Center, Clarksburg LEWIS HARDY WIRT UPSHUR Grant Memorial, Petersburg GILMER Pleasant Valley Hospital JACKSON CALHOUN RANDOLPH MASON WomenCare Birth Center PENDLETON ROANE Davis Memorial, Elkins BRAXTON St. Mary's Hospital St. Joseph's, Buckhannon Cabell Huntington Hospital WEBSTER CLAY PUTNAM CABELL Stonewall Jackson Memorial, Weston POCAHONTAS WAYNE KANAWHA NICHOLAS CAMC Women’s and Children’s LINCOLN FAYETTE Summersville General BOONE Thomas Memorial Hospital GREENBRIER LOGAN Logan General Hospital Greenbrier Valley Medical Center MINGO RALEIGH Williamson Memorial Hospital WYOMING SUMMERS MONROE Raleigh General Hospital MCDOWELL MERCER Princeton Community Hospital Welch Community Hospital Bluefield Regional Medical Center

  19. Where should we go from here?

  20. Where should we go from here? • WV leaders need to examine statistics more closely • Obstacles to maternal transport need to be studied. • A cost/benefit analysis of statewide maternal transport should be considered. • Quality Improvement Initiative

  21. Lawyers are like other people--fools on the average; but it is easier for an ass to succeed in that trade than any other.-quoted in Sam Clemens of Hannibal, Dixon Wecter

  22. Lawsuit in Iowa

  23. Do we need a Quality Improvement Initiative?

  24. Guidelines for Perinatal Care 2007 Quality Indicator: Delivery of an infant less than 32 weeks gestation in an institution without a NICU 1Guidelines for Perinatal Care, 6th Edition, co-published and endorsed by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists. 2007

  25. Some questions to ask • How long was the mother at the non-tertiary hospital before she gave birth to a baby weighing less than 1500 grams? • Was there an attempt to transport the mother? • If so what factors prevented her transport?

  26. THIS is the best incubator

  27. Being Born at the Right Place Isn’t it worth the price because it’s the right thing to do?

  28. Maternal Transport Log Available on Perinatal Partnership Website http://www.wvperinatal.org/

  29. Maternal Transport Log for Community Hospitals (Report multiple calls for same patient as separate entries)

More Related