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Center differences and outcomes of extremely low birth weight infants
Betty R Vohr1, Linda L Wright, Anna M Dusick
1Women and Infants Hospital, Providence, Rhode Island 02905, USA. betty_vohr@brown.edu
Insights
Extremely low birth weight infant outcomes varied significantly between centers, even after accounting for demographics. Specific neonatal interventions like postnatal steroids were linked to worse outcomes, while shorter ventilation and faster feeding improved results.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Clinical Research
Background:
- Multicenter studies reveal significant variations in neonatal care and outcomes.
- Previous research highlights center-specific differences in neonatal characteristics and morbidities.
Purpose of the Study:
- To evaluate center differences in outcomes for extremely low birth weight (ELBW) infants at 18-22 months.
- To identify neonatal interventions associated with observed outcome disparities after adjusting for demographics and antenatal factors.
Main Methods:
- Analysis of 2478 ELBW infants from 12 Neonatal Research Network centers (1993-1994).
- Logistic regression to assess center differences and the impact of four key neonatal interventions (resuscitation, postnatal steroids, ventilation duration, enteral feeding time) on adverse outcomes.
- Comprehensive evaluations of 1151 survivors at 18-22 months, focusing on cerebral palsy, low Bayley scores, and neurodevelopmental impairment (NDI).
Main Results:
- Significant center variations in mortality, interventions, morbidities, and neurodevelopmental outcomes were observed.
- Adjusted NDI rates ranged from 52% to 85% across centers.
- Active resuscitation and postnatal steroids correlated with increased NDI (11.8% and 19.3%), while shorter ventilation and faster enteral feeding correlated with decreased NDI (20.7% and 17.3%).
Conclusions:
- Substantial and concerning center-based differences in ELBW infant outcomes persist, even after controlling for demographic and antenatal variables.
- Investigating center-specific postnatal interventions offers potential hypotheses for clinical trials aimed at improving infant outcomes.
Objective:
Previous multicenter studies have shown significant center differences in neonatal characteristics and morbidities. This study evaluated center differences in outcome at 18 to 22 months among extremely low birth weight (ELBW; 401-1000 g) infants after adjusting for demographics and antenatal interventions, and it identified neonatal interventions associated with outcome differences.
Methods:
We assessed the outcome of 2478 liveborn infants who were admitted in 1993 and 1994 to the 12 centers of the Neonatal Research Network of the National Institute of Child Health and Human Development; 1483 (60%) infants survived to 18 to 22 months, and 1151 (78%) had comprehensive evaluations. Logistic regression analyses were performed to identify center differences and the association of 4 neonatal interventions--active resuscitation, postnatal steroids, ventilator treatment for < or =27 days, and full enteral feedings < or =24 days--with adverse outcomes (cerebral palsy, low Bayley scores, and neurodevelopmental impairment [NDI]), after adjusting for demographics and antenatal interventions.
Results:
Using bivariate analyses, significant center differences were identified for mortality, antenatal and postnatal interventions, social and environmental variables, neonatal morbidities, and neurodevelopmental outcomes for the 12 centers. After adjustment for maternal and infant demographics and antenatal interventions, the percentage of ELBW infants who had died or had NDI at 18 to 22 months ranged from 52% to 85%. Active resuscitation and postnatal steroids were associated with increases of NDI of 11.8% and 19.3%, whereas shorter ventilation support and shorter time to achieve full enteral feeds were associated with decreases in NDI of 20.7% and 17.3%, respectively.
Conclusion:
There are large and disturbing differences among centers in outcomes at 18 to 22 months after adjusting for demographic and antenatal interventions. Center differences in postnatal interventions associated with differences in outcome can provide hypotheses for testing in clinical trials to improve outcome.
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