Document Detail


The differential impact of delivery hospital on the outcomes of premature infants.
MedLine Citation:
PMID:  22778301     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Because greater percentages of women deliver at hospitals without high-level NICUs, there is little information on the effect of delivery hospital on the outcomes of premature infants in the past 2 decades, or how these effects differ across states with different perinatal regionalization systems.
METHODS: A retrospective population-based cohort study was constructed of all hospital-based deliveries in Pennsylvania and California between 1995 and 2005 and Missouri between 1995 and 2003 with a gestational age between 23 and 37 weeks (N = 1328132). The effect of delivery at a high-level NICU on in-hospital death and 5 complications of premature birth was calculated by using an instrumental variables approach to control for measured and unmeasured differences between hospitals.
RESULTS: Infants who were delivered at a high-level NICU had significantly fewer in-hospital deaths in Pennsylvania (7.8 fewer deaths/1000 deliveries, 95% confidence interval [CI] 4.1-11.5), California (2.7 fewer deaths/1000 deliveries, 95% CI 0.9-4.5), and Missouri (12.6 fewer deaths/1000 deliveries, 95% CI 2.6-22.6). Deliveries at high-level NICUs had similar rates of most complications, with the exception of lower bronchopulmonary dysplasia rates at Missouri high-level NICUs (9.5 fewer cases/1000 deliveries, 95% CI 0.7-18.4) and higher infection rates at high-level NICUs in Pennsylvania and California. The association between delivery hospital, in-hospital mortality, and complications differed across the 3 states.
CONCLUSIONS: There is benefit to neonatal outcomes when high-risk infants are delivered at high-level NICUs that is larger than previously reported, although the effects differ between states, which may be attributable to different methods of regionalization.
Authors:
Scott A Lorch; Michael Baiocchi; Corinne E Ahlberg; Dylan S Small
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-07-09
Journal Detail:
Title:  Pediatrics     Volume:  130     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-02     Completed Date:  2012-10-11     Revised Date:  2014-07-09    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  270-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Bronchopulmonary Dysplasia / mortality
California
Cause of Death
Cross Infection / mortality
Female
Hospital Mortality*
Hospitals, University / statistics & numerical data*
Humans
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature, Diseases / mortality*,  therapy
Infant, Very Low Birth Weight*
Intensive Care Units, Neonatal / statistics & numerical data*,  utilization
Missouri
Obstetric Labor, Premature / prevention & control
Outcome Assessment (Health Care)
Pennsylvania
Pregnancy
Retrospective Studies
Risk Assessment
Utilization Review
Grant Support
ID/Acronym/Agency:
R01 HS 015696/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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