Background and aims Studies have shown that very preterm infants (VPTI) have higher survival when they are born in a maternity unit associated with a high volume neonatal unit. We sought to analyse the impact of nursery volume on in-hospital mortality in Europe.
Methods Data come from the EPICE (Effective Perinatal Intensive Care in Europe) project, a population-based study of VPTI born in 19 European regions over 12 months in 2012–2013. We included all live births between 24 and 31 weeks of gestation without severe congenital anomalies (n = 7383) born in 350 maternity units. Volume was defined as the number of observed admissions to the neonatal unit associated with the delivery hospital. Our outcome was death before discharge home. We assessed the impact of volume, analysed as a continuous variable, using multi-level logistic regression and considering case-mix (gestational age, sex, small for gestational age, multiple pregnancy, maternal age and parity).
Results 8% of VPTI were born in maternity units with less than 10 neonatal admissions, 8% in units with 10 to 29 admissions, 11% in units with 30 to 49 admissions, 42% in units with 50 to 99 admissions and 31% in units with ≥100 admissions. After adjustment, we found a significant linear association between volume and in-hospital mortality, with an odds ratio of 0.95 (0.91–0.98) for 20 additional admissions.
Conclusions VPTI born in maternity units associated with high volume neonatal units had better survival. Delivery in matenity units with larger neonatal units may contribute to improved outcomes in this population.