Direct communication between neonatologists and obstetricians leads to better outcomes for infants in greater Cincinnati

Recommending that pregnant moms who are at high risk for preterm birth deliver at hospitals best equipped to handle the needs of their newborns is helping improve outcomes for very low birth weight infants in the Cincinnati area, according to a new Cincinnati Children’s Hospital Medical Center study.

Through direct communication between obstetricians and neonatologists, significantly more preterm babies are being delivered at perinatal subspecialty centers than a decade ago, according to Vivek Narendran, MD, a neonatologist at Cincinnati Children’s and the study’s senior author. Narendran is also the Medical Director of the Neonatal Intensive Care Unit & Newborn Nursery at the University Hospital.

"The division of neonatology at Cincinnati Children’s is uniquely positioned to effectively disseminate reliable and evidenced-based information to all maternity hospitals, as we are the sole provider of neonatal intensive care and transport services to the greater Cincinnati area,” says Narendran, who also directs the Cincinnati Perinatal Outreach Project. "The key to our success has been our longstanding relationships with maternity hospital administrators and community obstetricians.”

Results of the new study indicate that deliveries of infants weighing less than 1500 grams at birth and less than 32 weeks gestation at hospitals not considered perinatal subspecialty centers decreased from 25 percent between 1995 and 1997 to 11.8 percent between 2003 and 2007. Delivery hospitals with Level 3 newborn intensive care units are considered perinatal subspecialty centers.

This study will be presented at 7 p.m. ET Sunday, May 2, at the annual meeting of the Pediatric Academic Societies in Vancouver, Canada.

Guidelines set forth by the American Academy of Pediatrics and The American College of Obstetricians and Gynecologists recommend delivery of all infants prior to 32 weeks gestation at perinatal subspecialty centers to decrease neonatal morbidity and mortality. This study shows that neonatologist support and direct communication with obstetricians in greater Cincinnati is leading to increased awareness of and adherence to these guidelines.

The study also reiterated that the odds of death or significant morbidity for very low birth weight infants born at non-specialty centers is three times that of infants born at subspecialty centers after controlling for all demographic variations.

"Increasing the proportion of very low birth weight infants born at perinatal subspecialty centers is one of the key perinatal objectives listed in the Healthy People Objective 2010 guidelines issued and promoted by the United States Public Health Service,” says Narendran. "With our efforts, nearly 89 percent of very low birth weight infants born in Greater Cincinnati are delivered at subspecialty centers. To my knowledge, we are the only region in the country to achieve a level close to the 90 percent goal.”

Data for the study was obtained from The National Institute of Child Health and Human Development Neonatal Research Network registry, the Cincinnati Regional Perinatal Database, Ohio Department of Health and individual hospital-based records.