The Facts of Life
Regional information sharing gives needed insights into prematurity
Despite advances in caring for premature infants, doctors still know relatively little about what causes prematurity in the first place. Neonatologists at Cincinnati Children’s Hospital Medical Center are working with obstetricians and clinical staff at hospitals throughout Greater Cincinnati to share information that should help with that understanding.
The collaboration grew out of more than a decade of relationshipbuilding between Cincinnati Children’s neonatologists and area hospitals.
Getting Down to Details
Sharing data about preterm births is a basic and crucial step toward reducing prematurity and improving care of these tiniest newborns, says James Greenberg, MD, a neonatologist and director of the Division of Neonatology at Cincinnati Children’s. Yet it is a resource that few if any cities have because of competition for OB patients among hospitals. The physicians in the Division of Neonatology have overcome these competitive concerns by working closely with area hospital maternity units over the years, Greenberg says.
“This was possible because we’ve worked together for 15 years,” he says. “And doctors in this community have made the decision to do what’s right for babies.”
The decision they made was to share information about preterm babies born in this area. The doctors also share information about preterm birth from national data sources. Although the information currently comes from a variety of sources, Greenberg says, it will help provide answers to fundamental questions about prematurity.
“There are different causes and types of preterm birth, but right now if we ask how many are due to an incompetent cervix, how many due to premature rupture of membranes and how many are due to multiples, it’s nearly impossible to answer that basic epidemiologic question,” Greenberg says. “We want to collect data about preterm birth that will allow us to look at it with the same kind of detail that we can look at cancer or heart disease. Characterizing preterm birth with real data will help us look at real people and ask the right questions.”
Greenberg adds that he and others are working on developing a single, seamless data system that will make these efforts even easier.
Changing Doctors’ Practice – for Good
Because of the relationships they’ve built, the division’s neonatologists have also made inroads getting obstetricians to make an important change in their practice. Specifically, they have persuaded the doctors to transfer women in premature labor to hospitals with level-3 neonatal units. This avoids the need to transfer the baby in an ambulance after delivery, should the infant need special care.
The recommendation is based on a study published in 2004 by Barbara Warner, MD, who was a member of the neonatology faculty at Cincinnati Children’s at the time. The study, based on work done here, showed it was twice as risky for infants born before 32 weeks and weighing less than 1500 grams to be born in a non-specialty perinatal center.
The risk has nothing to do with the doctor or the facility, Greenberg assures. “It’s the ride,” he says. “If you put a baby in an ambulance, even with skilled personnel and a transport isolette, he doesn’t do as well.”
Doctors were open to making the change, Greenberg says, because they knew and trusted the neonatologists. The division has more than 30 neonatologists attending in local level-3 ICUs and providing coverage for high-risk deliveries at most area hospitals. “Because of our relationships with the OBs, we were able to tell them ‘This is what’s best for your patient and her soon-to-be-born child.’ And the good news is, we now have data demonstrating that they listened.”
Now, as many as 400 mothers in this region are transferred to a specialty perinatal center each year, at an average gestational age of 27.5 weeks. The percentage of babies born before 32 weeks gestation in the region in a non-specialty perinatal center has dropped from 25 to approximately 10 percent, a Healthy People 2010 goal.
The next step is seeing whether this change in practice has actually reduced mortality, using findings from the pooled databases.
“We asked OBs to move mothers because we thought it would reduce mortality risk,” Greenberg says. “Now we have an opportunity to see whether our collective efforts have succeeded. If they haven’t, it’s going to be interesting to see what we’ve been missing.”
James Greenberg, MD, is associate director, Perinatal Institute; director, Division of Neonatology; associate professor, Department of Pediatrics, University of Cincinnati College of Medicine.
