The influence of level of care on admission to neonatal care for babies of low-risk nullipara

Objective To analyze the risk of admission to neonatal care for newborns of low-risk nullipara and its variation with level of care of the maternity unit. Study design The sample included infants born to low-risk nulliparas from the PREMODA study of 138 French maternity units (n = 3652). Medical records of children admitted to neonatal care were reviewed to determine the reasons for admission and the severity of morbidity. The risk factors associated with admission to neonatal care, including maternal, infant and delivery unit characteristics, were studied by univariable analysis, followed by a multivariable analysis using a multilevel logistic model. Results The newborns of 3.5% (n = 129) of the nulliparous mothers at low risk were admitted to neonatal care at birth. The two principal reasons were infections (57%) and respiratory diseases (19%). Babies born in level 2 maternity units were twice as likely to be admitted to neonatal care as those born in level 1 units (ORa = 2.0 [1.1–3.7]) and those born in level 3 units, 1.5 times more often, although this was not statistically significant (ORa = 1.5 [0.8–2.8]). Babies admitted to neonatal care after delivery in level 1 had more severe morbidity (n = 4, 26.7%) than those admitted from level 2 (n = 4, 5.7%) or level 3 (n = 3, 6.8%) facilities (p = 0.046). Conclusion In low-risk populations, the level of care could have an influence on the decision to admit babies to neonatal care at birth. These findings add to the on-going debate about the optimal organization of care for women at low obstetrical risk