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Neonatal-Perinatal Health Care Delivery: Epidemiology/Health Services Research

Neonatal-Perinatal Health Care Delivery 3: Epi/HSR Antenatal Exposures and Neonatal Outcomes

760 - Maternal characteristics and regional organizational factors associated with outborn delivery of preterm infants <32 weeks

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 760
Publication Number: 760.246

Satit Manopunya, McGill University Faculty of Medicine and Health Sciences, Maung Chiang Mai, Chiang Mai, Thailand; Sharina Patel, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Bruno Piedboeuf, Faculty of Medicine Université Laval, Québec, PQ, Canada; Christine Drolet, Chu de Quebec, Quebec, PQ, Canada; Anie Lapointe, CHU Ste-Justine, Montréal, PQ, Canada; Victoria S.. Bizgu, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Edith Massé Massé, Universite de Sherbrooke Faculty of Medicine, Sherbrooke, PQ, Canada; Guy Lacroix, Université Laval, Québec, PQ, Canada; Marc Beltempo, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada

Presenting Author(s)

Satit Manopunya, MD (he/him/his)

Clinical Fellow in Neonatology andPerinatal Medicine
McGill University Faculty of Medicine and Health Sciences
Maung Chiang Mai, Chiang Mai, Thailand

Background: Preterm infants < 32 weeks gestational age (GA) born in hospitals without level 3 NICU (outborn) are at higher risk of adverse outcomes. A better understanding of risk factors related to outborn birth may help develop strategies to minimize outborn deliveries.

Objective: To identify maternal and region-organizational risk factors associated with outborn deliveries among preterm infants born < 32 weeks GA.

Design/Methods: This retrospective cohort study included infants born at 23-31 weeks' GA admitted to all five of Quebec’s NICUs participating in the Canadian Neonatal Network (CNN) from 2014 to 2018. Maternal and region-organizational factors included geographic distance to the closest level 3 units and unit occupancy on Level 2 and 3 NICUs associated with outborn deliveries were evaluated using logistic regression analysis.

Results: There were 2874 eligible infants corresponding to 2494 pregnancies of whom 314 (12.5%) delivered outborn (341 infants). Maternal characteristics associated with higher odds of outborn delivery were maternal age < 20 years (adjusted odds ratio (aOR) 3.45, 95% confidence interval (CI) 1.35-8.09) and spontaneous labor initiation (aOR 1.87, 95% CI 1.31-2.72 ). Geographic factors associated with higher odds of outborn delivery included longer travel time to the closest level 3 NICUs 30-60 minutes (aOR 1.48, 95% CI 1.01-2.15). Overall median regional and provincial unit occupancy in Level 2 and Level 3 NICUs on the day prior and the day of outborn birth were either similar or lower for the outborn group.

Conclusion(s): We identified clinical risk factors for outborn preterm birth and patients at further distances from Level 3 units are at higher risk of outborn delivery. In our highly regionalized healthcare system, occupancy is not a barrier to access to care. However, 43% (137/314) of outborn infants lived within 32 km of Level 3 NICUs which suggests places for improvement in referral patterns for women at risk of very preterm delivery.