Mortality rates among very low-birth weight (VLBW) infants vary according to both the volume of patients and the level of care at the hospital where they are born. In a study involving 48,237 VLBW infants who were born in California hospitals between 1991 and 2000, mortality was lowest among those infants born in hospitals with NICUs that had both a high level of care and a high volume of similar patients.1 Higher-level NICUs provide more critical services on site, such as mechanical ventilation and cardiac surgery. The staff in those facilities are also used to dealing with sicker babies and have systems in place for providing consistent care to large numbers of VLBW infants at once. In the lower-level NICUs that see fewer than 100 preterm infants each year, infant mortality rates go up, and in facilities that see fewer than 10 babies each year, the death rate rises dramatically. Not all expectant parents, especially those in rural areas, have access to a busy, high-level NICU, but where parents have a choice of facilities, this study suggests that delivering at a high-level, high-volume NICU might improve survival.

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