The influence of level of care on admission to neonatal care for babies of low-risk nullipara

Le Ray, C.; Zeitlin, J.; Jarreau, P.H.; Bréart, G.; Goffinet, F.; for the PREMODA study group,

doi:10.1016/j.ejogrb.2009.01.006

« Previous Next »European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 144, Issue 1 , Pages 21-26, May 2009

The influence of level of care on admission to neonatal care for babies of low-risk nullipara

C. Le Ray
- Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, 82 Avenue Denfert-Rochereau, 75014 Paris, France
- Université Paris-Descartes, Faculté de médecine, Maternité de Port-Royal, Hôpital Cochin Saint-Vincent-de-Paul, Assistance Publique Hôpitaux de Paris, 123 Bd de Port-Royal, 75014 Paris, France
J. Zeitlin
- Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, 82 Avenue Denfert-Rochereau, 75014 Paris, France
P.H. Jarreau
- Université Paris-Descartes, Faculté de médecine, Maternité de Port-Royal, Hôpital Cochin Saint-Vincent-de-Paul, Assistance Publique Hôpitaux de Paris, 123 Bd de Port-Royal, 75014 Paris, France
G. Bréart
- Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, 82 Avenue Denfert-Rochereau, 75014 Paris, France
F. Goffinet
- Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, 82 Avenue Denfert-Rochereau, 75014 Paris, France
- Université Paris-Descartes, Faculté de médecine, Maternité de Port-Royal, Hôpital Cochin Saint-Vincent-de-Paul, Assistance Publique Hôpitaux de Paris, 123 Bd de Port-Royal, 75014 Paris, France
- Corresponding author at: INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, 82 Avenue Denfert-Rochereau, 75014 Paris, France. Tel.: +33 1 42 34 55 70/42 34 55 80; fax: +33 1 43 26 89 79.
for the PREMODA study group

Received 8 August 2008; received in revised form 1 December 2008; accepted 19 January 2009. published online 11 February 2009.

Abstract

Objective

To analyze the risk of admission to neonatal care for newborns of low-risk nullipara and its variation with level of care of the maternity unit.

Study design

The sample included infants born to low-risk nulliparas from the PREMODA study of 138 French maternity units (n=3652). Medical records of children admitted to neonatal care were reviewed to determine the reasons for admission and the severity of morbidity. The risk factors associated with admission to neonatal care, including maternal, infant and delivery unit characteristics, were studied by univariable analysis, followed by a multivariable analysis using a multilevel logistic model.

Results

The newborns of 3.5% (n=129) of the nulliparous mothers at low risk were admitted to neonatal care at birth. The two principal reasons were infections (57%) and respiratory diseases (19%). Babies born in level 2 maternity units were twice as likely to be admitted to neonatal care as those born in level 1 units (ORa=2.0 [1.1–3.7]) and those born in level 3 units, 1.5 times more often, although this was not statistically significant (ORa=1.5 [0.8–2.8]). Babies admitted to neonatal care after delivery in level 1 had more severe morbidity (n=4, 26.7%) than those admitted from level 2 (n=4, 5.7%) or level 3 (n=3, 6.8%) facilities (p=0.046).

Conclusion

In low-risk populations, the level of care could have an influence on the decision to admit babies to neonatal care at birth. These findings add to the on-going debate about the optimal organization of care for women at low obstetrical risk.

Keywords: Level of care, Neonatal morbidity, Low-risk nulliparas