Unexpected complications in term newborns have been recently adopted by the Joint Commission as a marker of obstetric care quality. A study published in JAMA sought to understand the variation and patient and hospital factors associated with severe unexpected complications in term neonates among hospitals in the United States.
The study collected data from all births in US counties with 1 obstetric hospital using county-identified birth certificate data and American Hospital Association annual survey data from January 1, 2015, through December 31, 2017. A total of 1 754 852 births from 576 hospitals were included in the analysis.
The study found a wide range of hospital complication rates. Hospitals with high newborn complication rates were more likely to care for younger, white, less educated, and publicly insured women with more medical comorbidities compared with hospitals with low complication rates. Neonatal transfer was the primary factor associated with complication rates, especially among hospitals with the highest rates. The risk for unexpected neonatal complication increased by more than 50% for those neonates born at hospitals without a neonatal intensive care unit compared with those with a neonatal intensive care unit.
The study concludes severe unexpected complication rates among term newborns varied widely. When included in the metric numerator, neonatal transfer was the primary factor associated with complications, especially among hospitals with the highest rates. Transfers were more likely to be necessary when infants were born in hospitals with lower levels of neonatal care.