Impact of Birth Location on Survival and Hospital Stay for Very Preterm Infants

Approximately 10% of infants in the United States are born preterm, defined as before 37 weeks of gestation. Among these, infants with very low birth weights—less than 3.3 pounds—are often born extremely prematurely, at 29 weeks gestation or earlier. Although they represent just 1% of all births, they account for more than half of infant deaths annually. A recent study by researchers at Penn State highlights how the specific hospital or health system where a very preterm baby is born can significantly influence their survival chances and length of hospital stay.

Led by Professor Jeannette Rogowski, the research found that the immediate care setting—whether a baby is born in a high-performing or lower-performing hospital—can alter survival odds by around two percentage points. This variation underscores the potential for healthcare quality improvement across neonatal intensive care units (NICUs). The study, published in JAMA Network Open, analyzed data from the Vermont Oxford Network, a global infant care quality network, focusing on babies born between 24 and 29 weeks of gestation.

Data from 38,501 very preterm infants revealed an overall mortality rate of 8.7%. Notably, the lowest-performing systems had a mortality rate of 9.8%, while the top systems saw rates as low as 7.8%. The average hospitalization length was 81 days but ranged from 78 to 90 days between the highest and lowest performing systems. These findings imply that enhancements in healthcare delivery at the system level could improve outcomes and reduce hospital costs, especially since NICU stays for these infants are among the most expensive hospitalizations.

The study also emphasizes that infants born very preterm are at heightened risk for severe complications such as blindness, brain hemorrhages, and other health issues. The quality of care at birth plays a crucial role in influencing their long-term health trajectory, with potential lifetime implications.

Most very low birth weight infants (around 90%) are enrolled in the Vermont Oxford Network, which supports continuous improvement in neonatal care. This research suggests that targeted quality improvements—like staffing, resource allocation, and care practices—could significantly enhance survival rates and reduce hospital stays. Nevertheless, further investigation is needed to understand the factors driving variations across different health systems.

Rogowski emphasizes the importance of ongoing assessment of healthcare changes, particularly for vulnerable populations such as very preterm infants. The ultimate goal is to equip healthcare providers and systems with the data needed to offer the best possible care, ensuring healthier outcomes throughout life.