5-year morbidity among very preterm infants in relation to level of hospital care

JAMA Pediatr. 2013 Jan;167(1):40-6. doi: 10.1001/jamapediatrics.2013.415.


Objective: To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children.

Design: A cohort study.

Setting: Finland.

Participants: All surviving 5-year-old children born very preterm (gestational age <32 weeks or birth weight ≤1500 g) born in level II or level III hospitals (n = 2168) and full-term (gestational age, 37-42 weeks) children (n = 238 857) born from January 1, 2000, through December 31, 2004.

Main outcome measures: Diagnoses issued after the first discharge home and overrepresented in very preterm compared with full-term children. Diagnoses were analyzed between very preterm children (1) born and treated in level III hospitals (group III), (2) born in level III and transferred to lower-level hospitals (group III/II), and (3) born and treated in level II hospitals (group II).

Results: Group III/II children had an increased incidence of retinal disorders (odds ratio, 2.43 [95% CI, 1.66-3.56]) and asthma (1.41 [1.09-1.81]) but fewer viral infections (0.75 [0.59-0.95]) compared with group III infants. The risks for epilepsy (odds ratio, 2.71 [95% CI, 1.29-5.70]) and hyperkinetic disorders (2.19 [1.13-4.25]) were higher among group II than among group III children. No statistically significant differences between the groups for the 14 other diagnoses were found.

Conclusions: The increased incidence of retinopathy and asthma among infants transferred from level III to lower-level hospitals calls for analysis of the differences in treatment practices between hospital levels.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Cohort Studies
  • Female
  • Finland / epidemiology
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / etiology*
  • Infant, Premature, Diseases / therapy
  • Intensive Care, Neonatal*
  • Logistic Models
  • Male
  • Odds Ratio
  • Outcome and Process Assessment, Health Care
  • Patient Transfer*
  • Registries
  • Secondary Care*
  • Tertiary Care Centers
  • Tertiary Healthcare*