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David A. Bateman, MD; Laura O'Bryan; Stephen W. Nicholas, MD; Margaret C. Heagarty, MD

Arch Pediatr Adolesc Med. 1994;148(2):147-152.

Abstract
Objective
To determine the maternal risk factors and infant outcome for unattended out-of-hospital deliveries brought to an inner-city public hospital.

Methods
We compared 59 infants born alive out of hospital during 1989 with 151 randomly selected in-hospital live births, all with birth weight greater than 500 g.

Results
History of cocaine use during pregnancy (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.68 to 10.5) and lack of Medicaid or other health insurance (OR, 2.15; 95% CI, 1.04 to 4.45) were independently associated with out-of-hospital delivery. Out-of-hospital delivery was associated with hypothermia (defined as admission axillary temperature <35°C; OR, 20.8; 95% CI, 4.81 to 89.9) and with hypoglycemia (defined as admission glucose reagent strip reading <2.2 mmol/L [<40 mg/dL]; OR, 4.41; 95% CI, 1.29 to 15.1) in separate analyses controlling for birth weight and other risk factors. Polycythemia (venous or arterial hematocrit >0.65 at age 6 hours) occurred in 14% (eight of 59) of out-of-hospital births. The increased neonatal mortality rate for infants born out of hospital (20.3 vs 7.3 per 1000 live births; OR, 2.82; 95% CI, 1.23 to 6.47) was due to an excess of infants weighing 500 to 999 g.

Conclusions
Unattended out-of-hospital births result in increased neonatal morbidity that may be partly preventable by simple interventions used routinely at inhospital deliveries.

(Arch Pediatr Adolesc Med. 1994;148:147-152)

Author Affiliations
From the Department of Pediatrics, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.

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