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Maryland Perinatal System Standards, Revised 2004

Maryland Perinatal System Standards, Revised 2004. Summary of Efforts by the Perinatal Clinical Advisory Committee, Department of Health & Mental Hygiene. Maryland Perinatal System Standards, 2004.

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Maryland Perinatal System Standards, Revised 2004

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  1. Maryland Perinatal System Standards, Revised 2004 Summary of Efforts by the Perinatal Clinical Advisory Committee, Department of Health & Mental Hygiene

  2. Maryland Perinatal System Standards, 2004 • Consensus document developed by a 33-member committee representing 16 Maryland professional organizations • 3rd major updating of Maryland perinatal standards that have been in existence since 1995 • Consistent with Guidelines for Perinatal Care, 5th Edition, 2002 issued by AAP/ACOG • Consistent with AAP 2004 Policy Statement on Levels of Neonatal Care • Standards facilitate consistent service provision, represent professional consensus, informs the public, and permits comparisons for outcomes among institutions

  3. Perinatal Standards:National Perspective • 1972 – March of Dimes formed the Committee on Perinatal Health (COPH) • 1976 – COPH issued Toward Improving the Outcome of Pregnancy (TIOP I) that defined standards for perinatal regionalization • 1985 – Robert Wood Johnson Foundation Report on perinatal regionalization demonstrated improved pregnancy outcomes • 1993 – COPH updated Toward Improving the Outcome of Pregnancy (TIOP II) • 2002 – Guidelines for Perinatal Care, 5th Edition, issued by AAP and ACOG supports TIOP II standards

  4. Perinatal Standards: Maryland’s Perspective • 1989 – Maryland AAP’s Fetus and Newborn Committee developed nursery guidelines • 1995 – DHMH Secretary’s Perinatal Clinical Advisory Committee issued voluntary Maryland Guidelines for Perinatal Care • 1998 – Perinatal Clinical Advisory Committee updated Maryland Perinatal System Standards • Level III and IV standards adopted by MIEMSS for maternal-neonatal transport purposes and MHCC for certificate of need purposes • 2004 – Perinatal Clinical Advisory Committee updated Maryland Perinatal System Standards

  5. Perinatal Outcomes: Maryland • Infant mortality rate declined by 11% from the early 1990’s to early 2000’s • (9.1/1000 in 92-96 to 8.2/1000 in 97-01) • Neonatal mortality rate declined by 5% • Postneonatal mortality rate declined by 22% • VLBW-specific neonatal mortality rates improved • For all hospitals: 148/1000 to 132/1000 • For Level III & IV hospitals: 142/1000 to 129/1000 • Fewer Level III and IV hospitals now have NMR’s greater than 200/1000 (4 to 1)

  6. Birth Weight-Adjusted Neonatal Mortality Rates, By Maryland Level III & IV Hospital 1994-1995 1999-2000

  7. Maryland Perinatal Clinical Advisory Committee, 2004 • American Academy of Pediatrics, Maryland Chapter • American College of Nurse-Midwives, Maryland Chapter • American College of Obstetricians & Gynecologists, Maryland Chapter • Association of Women’s Health, Obstetric & Neonatal Nurses • Association of Social Workers, Maryland Chapter • Department of Health and Mental Hygiene • Maryland Academy of Family Physicians • Maryland Association of County Health Officers • Maryland Health Care Commission

  8. Maryland Perinatal Clinical Advisory Committee, 2004 • Maryland Hospital Association • Maryland Institute for Emergency Medical Services Systems • Maryland Commission on Infant Mortality Prevention • Maryland Perinatal Association • Maryland Society of Anesthesiologists • Med-Chi • Obstetrical and Gynecologic Society of Maryland

  9. Definitions of Levels of Care, 2004: Level I • Basic care to pregnant women and infants • Delivery room and normal newborn care for stable infants  35 weeks gestation • Maternal care limited to term and near-term gestations • Other than emergency stabilization, neonatal units do not provide mechanical ventilation • No pediatric subspecialty or surgical specialty services • Do not receive primary infant or maternal referrals

  10. Definitions of Levels of Care, 2004: Level IIA • Specialty care to pregnant women and infants • Delivery room and specialized care for stable infants  1,500 grams or  32 weeks gestation • Maternal care limited to term and preterm gestations • Neonatal units may provide conventional mechanical ventilation only in stabilization situations • No pediatric subspecialty or neonatal surgical specialty services • Do not receive primary infant or maternal referrals

  11. Definitions of Levels of Care, 2004: Level IIB • Specialty care to pregnant women and infants • Delivery room and acute specialized care for stable infants  1,500 grams or  32 weeks gestation • Maternal care limited to term and preterm gestations • Neonatal units may provide conventional mechanical ventilation, limited in technique and duration • May provide limited pediatric subspecialty services • No neonatal surgical specialty services • Do not receive primary infant or maternal referrals

  12. Definitions of Levels of Care, 2004: Level IIIA • Subspecialty care to pregnant women and infants • Acute delivery room & neonatal intensive care unit (NICU) care for infants  1,000 grams or  28 weeks gestation • Maternal care spans the range of normal term gestation care to the management of moderate prematurity and moderately complex maternal complications • Neonatal units provide conventional mechanical ventilation and offer continuous availability of neonatologists • May provide some pediatric subspecialty services • No neonatal surgical specialty services • May provide maternal or neonatal transport

  13. Definitions of Levels of Care, 2004: Level IIIB • Subspecialty care to pregnant women and infants • Acute delivery room and neonatal intensive care unit (NICU) care for infants of all birth weights and gestational ages • Maternal care spans the range of normal term gestation care to the management of extreme prematurity and moderately complex maternal complications • Neonatal units provide multiple modes of neonatal ventilation and offer continuous availability of neonatologists • Provide some pediatric subspecialty services • May provide some neonatal surgical specialty services • May provide maternal or neonatal transport

  14. Definitions of Levels of Care, 2004: Level IIIC • Subspecialty care to pregnant women and infants • Acute delivery room and neonatal intensive care unit (NICU) care for infants of all birth weights and gestational ages • Maternal care spans the range of normal term gestation care to that of highly complex or critically ill mothers • Neonatal units provide advanced modes of neonatal ventilation and life support and offer continuous availability of neonatologists • Extensive pediatric subspecialty services and pediatric subspecialty surgical services are available, including cardiothoracic open-heart surgery and neurosurgery • Provides maternal and neonatal transport

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