Neonatal Outcomes from a Comprehensive Prematurity Prevention Program

Abstract

Premature births are related to devastating long-term physical complications for newborn infants. To decrease these infant complications and the ensuing extreme financial expenses, Lovelace Health Systems in Albuquerque, New Mexico, developed and implemented a comprehensive Prematurity Prevention Program for all high-risk obstetric patients. The major program components have included program coordination, nutrition counseling, social services, and antenatal testing. The objective of this study was to compare corresponding neonatal outcomes from the 12 months prior to the beginning of the program to each of the first three working years of the program to determine whether outcome improvements were achieved and maintained. Total preterm delivery rates were significantly reduced in 1995–1996 (year 3) in comparison with 1992–1993 (year prior to the program's initiation). During 1993—1994 (year 1) and 1995–1996 (year 3), preterm delivery rates caused by preterm labor only were also significantly decreased. For each of the first three working years, statistically significant reductions were demonstrated in neonatal intensive care unit (NICU) admissions and in preterm deliveries with subsequent NICU infant admissions. The annual costs at Lovelace for high-risk maternal transfers to the University of New Mexico Hospital decreased from $1.14 million in 1992 (year prior) to $399,553 in 1996 (year 4). Low-birth-weight (<2500 g) and very-low-birth-weight (<1500 g) rates continued to be substantially below national and New Mexico figures during each of the first three years of the program. The primary factors contributing to the program's positive neonatal outcomes have included early recognition and intervention in high-risk patients, close support of high-risk patients, and resolution of communication issues between institutions, departments, and staff members.