CHOP Neonatologists’ Research Published in JAMA

Birth is riskier for both mothers and babies in the United States, compared to many other countries — with higher rates of maternal and infant mortality, preterm birth, and serious medical complications. For example, maternal mortality increased by 26% between 2000 and 2014, and in 2016 infant mortality rates in the United States were worse than 32 other similarly developed countries.

A team from the Division of Neonatology at Children’s Hospital of Philadelphia (CHOP) argues that an underlying reason for these adverse outcomes is that perinatal care is fragmented, and recommends that healthcare systems need to consider the mother and infant as a pair, or dyad, to better provide coordinated care.

“The mother-baby dyad has a special, dynamic relationship and their healthcare needs and outcomes are likely related,” said Sara Handley, MD, an attending neonatologist at CHOP and lead author of a viewpoint article in the July 8, 2019, Journal of the American Medical Association.

Handley and her colleagues write that as healthcare policy makers and leaders have organized perinatal care into regionalized systems with designated levels of care, they have created a siloed approach that disconnects risk-appropriate resources for maternal care from those resources for infant care. For example, critical care obstetric units may be geographically separate from neonatal intensive care units, rather than at the same center. Paralleling this issue, specialty physicians in maternal-fetal medicine and neonatology are not similarly distributed across the country and may not be available in appropriate locations.

“Better understanding of how to coordinate care for the mother-baby dyad can enable obstetricians and pediatricians to work together, along with other specialists to improve outcomes both in healthcare systems and across state lines,” said Dr. Handley.

Read the full article.