W.N. Spellacy

A system to monitor patient care in a perinatal region

Abstract A system to monitor the quality of perinatal health care in terms of the outcomes of pregnancy has been implemented at the University of Illinois. The computerized system can be extended to other regional networks. The systems design, its analysis and use, its potential impact on patient care, its acceptability to providers, and its costs, confidentiality, reliability, and transferability are discussed in this paper.

PLACE OF BIRTH FOR VERY LOW BIRTHWEIGHT VLBW (1500 GRAMS) INFANTS: DOES IT MATTER?

To evaluate the effect of place of birth on the morbidity and mortality of VLBW infants, we analyzed data (320 variables from each mother-infant pair collected prospectively) from 25, 120 infants born in our Perinatal network of 3 Level III (L. III) and 9 Level II (L. II) hospitals over an 18 month period. 397 VLBW and 2145 low birth weight infants (<2500 gm, LBW) formed a subset. L. III hospitals have pediatric and OB residencies, and perinatal fellowship programmes: only 3/9 L II hospitals have pediatric and OB residencies. Results. L III centers cared for a greater fraction of mothers on public aid (45% Vs 29%, P<0.0001), and teenage mothers (<16 years, 5% Vs 2%, P<0.001). Total perinatal and neonatal mortality rates (PMR, NMR) were higher in L III than in L II (16.3 and 106 Vs 10.1 and 4.7) which was mainly due to a 150% and 268% higher VLBW and LBW rates. However, for VLBW infants born in L III, 5 minute Apgar score distribution was significantly superior and PMR was better than for those born in L II. These data indicate that for the high risk VLBW infants, availability of supportive services is cruial for good outcome; fetal transfer may be better than high risk neonatal transfer.