Neonatal Mortality of Very Low Birth Weight Infants

Although the infant mortality rate in Louisiana has decreased, Louisiana still has one of the highest infant mortality rates in the nation. Two-thirds of the infant deaths occur in the neonatal period (birth through 28 days of age). The primary factor associated with death in the neonatal period is low birth weight. However, the likelihood of survival for low birth weight infants can be influenced by the quality of neonatal care received after birth. For this reason, it is recommended that pregnant women at high risk for delivery of a low birth weight infant be transferred to hospitals with high levels of neonatal care for labor and delivery. In 1994, the Louisiana Commission on the Perinatal Care established standards for neonatal care in the state based on type of patients, staffing, and availability of specialists. Level I neonatal units provide care for healthy newborns and stabilization of unexpectedly small or sick newborns before transfer to a hospital with a higher level of neonatal service. Level II neonatal units provide management of small, sick neonates with a moderate degree of illness. Level III neonatal units provide comprehensive care of all highrisk neonates. Of the 73 hospitals that deliver infants in Louisiana, 29 hospitals have Level III neonatal units, including six hospitals designated as Level III regional centers. To begin to understand the effectiveness of higher-level neonatal care in Louisiana, the Maternal and Child Health Section analyzed a linked live birth/infant death file for 19911996 to determine the birth weight-specific neonatal mortality rates for Level I, Level II and Level III neonatal units. Special emphasis was placed on the outcome of infants of very low birth weight (500 1,500 grams). During this time period, 1.7% (7,039/416,302) of infants were of very low birth weight (VLBW). Infants were more likely to be VLBW if their mothers were black (2.7%), under 20 years of age (2.1%), unmarried (2.4%), or had no prenatal care (6.8%; Table 1). Of the 7,039 infants with VLBW, 69.5% were born at Level III hospitals, 3.0% were born at Level II hospitals, and 27.5% were born at Level I hospitals.