O3308: Characteristics and Outcomes of Out-of-Hospital-Births in Las Vegas, Nevada

Background: The incidence of out-of-hospital births (OOHB) is increasing in Nevada, accounting for 1.8% of all births in 2020, translating into more than 450 OOHBs in Las Vegas annually. EMS agencies are called to attend with the mother-baby dyad being transported to local hospitals. The literature suggests that OOHB have increased rates of neonatal morbidity and mortality. Characteristics and outcome data on OOHB in Las Vegas have yet to be gathered. Sunrise Children's Hospital was chosen as the site to collect data with the largest NICU and maternity services in Las Vegas.

Methods: The authors collected data from chart reviews of cases at the Sunrise Labor and Delivery unit. Patient outcome was evaluated by comparing the incidence of hypothermia, respiratory distress, presence of substance use, rate of prenatal care, prematurity, and subsequent prognosis.

Results: From July 2021 to December 2023, 93 cases of OOHB were brought into Sunrise by EMS. Of the 93 births, 11 suffered out-of-hospital fetal demise - 9 demises were pre-viable at 14-22 weeks gestation, and two demises were extremely premature between 22-27 weeks gestation. Thus, 82 of the OOHB arrived at the hospital alive. Two additional infant deaths were noted in the emergency room, resulting in 80 / 93 infants being admitted for medical management - 39 to NICU and 41 to the Well Baby Nursery.
One of the most prevalent trends noted among OOHB was the poor prognosis among infants born < 32 weeks gestation. There were eight infants < 32 weeks (9.8% of the total), of which six did not survive (75%), and the surviving two had severe impairments. All eight patients arrived receiving "advanced life support" measures.
There was also a higher incidence of hypothermia (40/82 - 49%) and respiratory distress (26/82 - 32%). Early identification and management of these conditions is essential.
Additionally, there were higher rates of no prenatal care and higher rates of in-utero substance exposure. 72% of mothers reported no prenatal care compared to current estimates of 6% for all births in Nevada. Also, 61 of the 82 mothers had toxicology screens done, with 64% testing positive for illicit drugs, excluding THC, some more than one. 72% tested positive for amphetamines, and 41% tested positive for opioids.

Conclusion: The data demonstrated that OOHB have the following risks.
• Higher rate of neonatal demise
• Higher rate of premature births
• Higher rates of intrauterine drug exposure
• Higher rate of hypothermia/respiratory distress
Given this data, EMS training programs can be tailored to address this risk with the expectation of improved clinical outcomes.