Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Mar 28, 2024
Open Peer Review Period: Mar 28, 2024 - May 23, 2024
Date Accepted: Oct 29, 2024
(closed for review but you can still tweet)
Assessing the Impact of Distance Traveled and Birth Volumes of Hospital Maternity Units on Newborn Outcomes: A Population-based Cohort Study
ABSTRACT
Background:
Since the 1980s, several European healthcare systems have focused on centralizing childbirth and newborn care in large maternity units.
Objective:
This study aimed to evaluate the association between hospital maternity unit (HMU) volume, road travel distance (RTD) to the hospital, and neonatal outcomes.
Methods:
We conducted a population-based cohort study including all live births in hospitals without intensive care units (ICUs) between 2016 and 2019 in the Lombardy region, Italy. We evaluated the relationship between the risk of being transferred and/or death after birth and a low Apgar score at five minutes with HMU volume and RTD, using logistic regression analysis with a random intercept on the hospital. We controlled for several potential confounders, including the antenatal care path.
Results:
Out of 65,083 live births, 71% occurred in low-volume hospitals (<1000 births/year) and 21% involved long-distance travel (>15 km). The risk of transfer and/or death increased as HMU volume decreased, ranging from 1% for hospitals with 1000–1500 births/year to 4% for hospitals with <500 births/year (compared to high-volume hospitals). Travel distance did not affect the outcome. Neither HMU volume nor RTD were significantly associated with low Apgar scores. Additionally, high-volume hospitals exhibited a flattening of the prevalence curve for the outcome.
Conclusions:
Our findings showed an excess risk of neonatal transfer and/or death for live births delivered in HMUs with low activity volume and without an ICU. In contrast, the RTD did not affect the outcomes. Clinical Trial: N/A
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