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Am J Perinatol 2023; 40(01): 035-041
DOI: 10.1055/s-0041-1727222
Original Article

Association of Rural and Frontier Residence with Very Preterm and Very Low Birth Weight Delivery in Nonlevel III NICUs

Stephanie L. Bourque
1   Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
,
Blair W. Weikel
1   Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
,
Kristin Crispe
2   Department of Family Medicine, University of Colorado, Aurora, Colorado
,
Sunah S. Hwang
1   Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
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Abstract

Objective Delivery of very preterm and very low birth weight neonates (VPT/VLBW) in a nonlevel III neonatal intensive care unit (NICU) increases risk of morbidity and mortality. Study objectives included the following: (1) Determine incidence of VPT/VLBW delivery (<32 weeks gestational age and/or birth weight <1,500 g), in nonlevel III units in Colorado; (2) Evaluate the independent association between residence and nonlevel III unit delivery; (3) Determine the incidence of and factors associated with postnatal transfer.

Study Design This retrospective cohort study used 2007 to 2016 Colorado birth certificate data. Demographic and clinical characteristics by VPT/VLBW delivery in level III NICUs versus nonlevel III units were compared using Chi-square analyses. Multivariable logistic regression was used to estimate the independent association between residence and VPT/VLBW delivery.

Results Among patients, 897 of 10,015 (8.96%) VPT/VLBW births occurred in nonlevel III units. Compared with infants born to pregnant persons in urban counties, infants born to those residing in rural (adjusted odds ratio [AOR] = 1.58, 95% confidence interval [CI]: 1.33, 1.88) or frontier (AOR = 3.19, 95% CI: 2.14, 4.75) counties were more likely to deliver in nonlevel III units and to experience postnatal transfer within 24 hours (rural AOR = 2.24, 95% CI: 1.60, 3.15; frontier AOR = 3.91, 95% CI: 1.76, 8.67). Compared with non-Hispanic Whites, Hispanics were more likely to deliver VPT/VLBW infants in nonlevel III units (AOR = 1.36, 95% CI: 1.15, 1.61).

Conclusion A significant number of VPT/VLBW neonates were born in nonlevel III units with associated disparities by race/ethnicity and nonurban residence.

Key Points

  • Preterm delivery in a nonlevel III NICU increases risk of neonatal morbidity and mortality.

  • A significant number of preterm deliveries in Colorado occur in hospitals with nonlevel III NICUs.

  • Disparities in preterm delivery by race/ethnicity and nonurban residence exist.

Keywords

preterm delivery - very low birth weight - regionalization of care - neonatal transport


Publication History

Received: 08 January 2021

Accepted: 25 February 2021

Article published online:
20 April 2021

© 2021. Thieme. All rights reserved.

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