Impact of Perinatal Health Care Organization on Mortality of Low Birth Weight Infants in the Federation of Bosnia and Herzegovina

Aim.Goal of the study was to assess the frequency of birth and mortality of low birth weight infants based on the level of neonatal institution where they were born and/or treated according to gestational age, in the Federation of Bosnia and Herzegovina. Methods. Through the prospective study over one-year period from 01.01. to 31.12.2009, the infants were analysed (stillborn and liveborn) of both genders, gestational age 24-42 weeks and birth weight below 2500 grams. Results. During the assessment period, 22897 infants were born, 669 with low birth weight, so that the incidence was 2.9 %. Gender breakdown is proportional. Most of the infants were born in two largest Cantons, Sarajevo and Tuzla. In the first level neonatal institutions 29 infants were born, 286 in the neonatal institutions of the second level, and 354 low birth weight infants were born in the neonatal institutions of third level. There is statistically significant discrepancy in frequency of low birth weight infants' births between neonatal institutions of first and second level (χ2=272.1; P<0.0001), as well as second and third level (χ2=13.4; P<0.0002). Of 29 low birth weight infants born in neonatal institutions of first level, 26 were referred to other institutions, while 3 died in the institution where they were born. Neonatal institution of second level kept 127 infants at treatment, 53 of whom died. There was no statistically significant discrepancy in mortality of low birth weight infants between the institutions of first and second level (χ2=0.71; P=0.398), with relative risk [ RR=0.507 (95% CI 0.148- 1.738) ]. In third level neonatal institutions, 513 infants were treated and 461 survived, while 52 died. Statistically significant discrepancy was found in the mortality rate of low birth weight infants between the institutions of second and third level ( χ2=71.8; P<0.0001), with high relative risk [ RR=6.349 (95% CI 4.030-10.003) ]. Conclusion: Survival of low birth weight infants born in the maternity hospitals with neonatal institutions of third level is statistically higher than the survival rate of infants born in the maternity hospital with neonatal institutions of first and second level.