The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures for the 2015-2017 grant cycle. Performance Measure 3 is the percent of very low birth weight (VLBW) infants born in the hospital with a Level III+ Neonatal Intensive Care Unit (NICU). This evidence brief points to a selection of resources for state MCH programs on risk-appropriate care for VLBW infants, with an emphasis on evidence based information.
The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
Very low birth weight infants (‹1,500 grams or 3.25 pounds) are the most fragile newborns. Although they represented less than 2% of all births in 2010, VLBW infants accounted for 53% of all infant deaths, with a risk of death over 100 times higher than that of normal birth weight infants (>=2,500 grams or 5.5 pounds). VLBW infants are significantly more likely to survive and thrive when born in a facility with a level-III Neonatal Intensive Care Unit (NICU), a subspecialty facility equipped to handle high-risk neonates. In 2012, the AAP provided updated guidelines on the definitions of neonatal levels of care to include Level I (basic care), Level II (specialty care), and Levels III and IV (subspecialty intensive care) based on the availability of 62 appropriate personnel, physical space, equipment, and organization. Given overwhelming evidence of improved outcomes, the AAP recommends that VLBW and/or very preterm infants (‹32 weeks' gestation) be born in only level III or IV facilities. This measure is endorsed by the National Quality Forum (#0477).
Read More about Performance Measure 3
Performance Measure 3
Percent of very low birth weight (VLBW) infants born in the hospital with a Level III+ Neonatal Intensive Care Unit (NICU)
To ensure that higher risk mothers and newborns deliver at appropriate level hospitals
Numerator: VLBW infants born in a hospital with a level III or higher NICU
Denominator: VLBW infants (‹1500 grams)
Healthy People 2020 Objectives
Related to Maternal, Infant, and Child Health (MICH) Objective 33: Increase the proportion of VLBW infants born at level III hospitals or subspecialty perinatal centers (Baseline: 75%, Target: 83.7%)
Data Sources and Data Issues
Linked birth certificate and hospital data on NICU levels from American Academy of Pediatrics (AAP)
Data and Statistics
- Berns SD (ed.). 2010. Toward improving the outcome of pregnancy III: Enhancing perinatal health through quality, safety and performance initiatives. White Plains, NY: March of Dimes.
- Brantley, MD, Goodman, DA, Callaghan, W, Barfield, W. ca. 2013. Landscape of perinatal regionalization: A geospatial view of of perinatal critical care in the United States, 2010-2013. Atlanta, GA: National Center for Disease Prevention and Health Promotion.
- Henderson ZT, Suchdev DB, Abe K, Johnston EO, Callaghan WM. 2014. Perinatal quality collaboratives: improving care for mothers and infants. Journal of Womens Health 23(5):368-372. View abstract.
- Lasswell SM, Barfield WD, Rochat RW. 2010. Perinatal regionalization for very low-birth weight and very preterm infants: A meta-analysis. JAMA 304(9):992-1000. Database of Abstracts of Reviews (DARE) quality-assessed review.
- Nowakowski L, Barfield WD, Kroelinger, Lauver CB, Lawler MH, White VA, Ramos LR. 2012. Assessment of state measures of risk appropriate care for very low birth weight infants and recommendations for enhancing regionalized state systems. Maternal and Child Health Journal 16(1): 217-227. View abstract.
- Petrini, J. 2014. Perinatal regionalization: A Report to the Secretary's Advisory Committee (SACIM) on Infant Mortality. Rockville, MD: Secretary's Advisory Committee on Infant Mortality. Provides a definition of perintal regionalization, statistics on infant mortality in general, odds of death of VLBW infants born at non-level III hospitals, and percent of VLBW infants born at level III hospitals in regions IV and VI. Opportunities for states are mentioned.
- Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. 2007. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. New England Journal of Medicine 356(21):2165-75.
- Rashidian A, Omidvari AH, Vali Y, Mortaz S, Yousefi-Nooraie R, Jafari M, Bhutta ZA. 2014. The effectiveness of regionalization of perinatal care services—a systematic review. Public Health. 128(10): 872-885. View abstract.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 76.
Very Low Birth Weight in Level III NICU: Evidence Brief, 1st ed. (November 2014).
Author: Beth DeFrancis, M.L.S., NCEMCH