510 DIFFERENCES IN NEONATAL (NB)MORTALITY OUTCOME IN NB CARED FOR AT LEVEL I HOSPITALS

Abstract

In studying the effectiveness of NB transport (NCHSR #5-R18-H S03832), an evaluation was done on NB (<2000g). Of the 333 studied in 1979 [67% were transported (T) after initial care & the rest were matched non-transported (NT)]. 178 were born at a Level IA (community hospitals c some visiting neonatal consultation but generally scarce resources & 155 at a Level IB (community hosp, c no neonatal input). In all available data, there was no signif. diff.* between those born in IA & IB with respect to the following: BW (1410±441g, 1483±478g respectively), apgar score (7.4±2.8+7.1±3.2 respectively), sex (52% males in IA & 46% in IB), body temperature (96.0 in IA & 95.8 in IB) the mean hours of transports <8 hrs. (3.0±1.3 for IA + 2.9±1.2 for IB) or the %. of toxemia, fetal distress or previous neonatal death, t, x², & Mantel Haenszel (M-H) testing was used.

Results: 1) there was NS* in mortality between IA & IB as a group(x²=0.7)* or when adjusted in 3 wt. categories (≤1000, 1001-1500, 1501-2000). M-H x²= 1.22*. This was also true when analyzing only T (x²=2.66)* & only NT (x²=3.32)* in IA & IB. 2) IB has an improved survival (.65) compared to IA (.44) when adjusting for wt. in sick (Ap.<6) T (M-H x²=7.42)** This diff. was not apparent for sick NT or for well (Ap.>7) T. 3) sick (Ap.<6) black T neonates had a signif. increased survival from Level IB compared to Level IA in wt.-adjusted groups <1500g. M-H x²=5.14.** This diff. was not seen in well (Ap, 7) T or NT black NB. Adjusting for wt. T status, apg & ethicity is essential in comparing mortality data.

* P>.05 NS ** P<.025 SIG.

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