The Stepwise Care of Very Low Birth Weight Infants in Germany and Internationally

Objective In Germany the care of newborn infants is regulated by directives of the Federal Joint Committee. Assignment to the four levels of care, with level 1 being the highest level, is based on maternal risk factors, maternal and fetal diseases, birth weight and gestational age. This article compares birth weight and gestational age limits used in Germany with international regulations. Methods A manual search of websites of medical societies and regulative bodies in Europe, Northern America and Australia for regulations and guidelines was performed. Results Outside of Germany, level 1 is the lowest level of care. 2 to 7 levels are used. In Germany a birth weight < 1250 g and a gestational age < 29 + 0 weeks of gestation require treatment at the highest level. Internationally, the assignment to the highest level is most frequently defined by a birth weight of 1250 g or 1500 g. Birth weight is often associated with gestational age. The American Academy of Pediatrics refers to a meta-analysis in which the mortality was significantly lower if preterm infants with less than 1500 g and 32 + 0 weeks of gestation were born and treated in a highly specialized hospital. Conclusions Birth weight and gestational age limits for the assignment of preterm infants to different levels of care are internationally inhomogeneous. Only one guideline provides a scientific justification for the assignment rules.