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Whose Very Low Birth Weight Babies were at Risk to be Born in Lower Level Facilities in Louisiana?

Whose Very Low Birth Weight Babies were at Risk to be Born in Lower Level Facilities in Louisiana?. Lyn Kieltyka, PhD, MPH Ashley Chin, PhD, MPH, MA Tri Tran, MD, MPH. Background. Very low birth weight births (VLBW, 500-1500g) significantly contribute to high infant mortality

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Whose Very Low Birth Weight Babies were at Risk to be Born in Lower Level Facilities in Louisiana?

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  1. Whose Very Low Birth Weight Babies were at Risk to be Born in Lower Level Facilities in Louisiana? Lyn Kieltyka, PhD, MPH Ashley Chin, PhD, MPH, MA Tri Tran, MD, MPH

  2. Background • Very low birth weight births (VLBW, 500-1500g) • significantly contribute to high infant mortality • VLBW births in level III improves survival • Additional studies suggest relationship with NICU census and Infant / nursing staff ratio

  3. MMWR • US VLBW births have increased from 1980 – 2000 • 24.3% for all races • 23.8% for black women • 26.7% for white women S Lyasu & K Tomashek, MMWR, 2002, 51(27); 589-92

  4. 2004 VLBW Births

  5. Louisiana Birth Weight

  6. VLBW Births in Level III facilities • HP2010 goal = 90% • Block Grant National performance measure • Louisiana steadily improving in recent years • 86% of VLBW delivered in Level III in 2004

  7. Comparison of Very Low Birth Weight Neonatal Deaths among Infants Born in Level I-II versus Level III Hospitals, Louisiana, 1997-2003Neonatal Mortality Rate by age at death, among 500+g births *Level of delivery hospital

  8. Survival Time Distributions of VLBW Live Births in the Neonatal Period by Hospital Level, LA, 1997-2003 • 88.3% survival for Level III births • 84.4% survival for Level I-II births • Longer survival time p < 0.0001

  9. Research Question • Among VLBW births in Louisiana, what factors are associated with delivery at lower level facilities?

  10. Methods • 1998-2004 cohort linked birth/death records • Births 500-1,500g • Risk factors/markers of interest: • Maternal race, age, education, medical risks, prenatal care adequacy, geographic area, Medicaid status, newborn birth weight, and newborn complications (anemia, RDS, meconium aspiration) • Chi-square and multivariable logistic regression, SAS v9

  11. Maternal Characteristics

  12. Maternal Characteristics

  13. Odds of Birth in Level I-II facility

  14. Odds of Birth in Level I-II facility

  15. Conclusions • Characteristics significantly associated VLBW newborns in Level I-II facilities were: • Black race • High school education or less • Living in a rural area • Having inadequate prenatal care • Having any abnormal infant condition • Birth weight > 1000g

  16. Limitations • Reporting of live births and deaths • No assessment of hospital specific or individual provider practices or quality of care

  17. Public Health Implications • Identifying women at high risk of delivering in lower level facilities helps target efforts to improve Level III VLBW deliveries • Education to providers and patients • Perinatal Commission recommendations on hospital level congruence for women and children

  18. Additional Information Lyn Kieltyka, PhD Louisiana Office of Public Health rlkielty@dhh.la.gov

  19. Louisiana Infant Mortality Trend1991 - 2004 p < 0.1* p < 0.05* *Join point regression

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