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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

Individual and center-level factors affecting mortality among extremely low birth weight infants

Brandon W Alleman1, Edward F Bell, Lei Li

  • 1Department of Pediatrics, University of Iowa, Iowa City, IA 52242, USA.

Pediatrics
|June 12, 2013
PubMed

Insights

Center intervention rates impact mortality for extremely low birth weight (ELBW) infants, particularly those born very preterm (<25 weeks gestational age). Standardizing care may prevent deaths, though not all variations are explained by interventions or patient factors.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Public Health

Background:

  • Significant variations in mortality rates exist among Neonatal Research Network centers for extremely low birth weight (ELBW) infants.
  • Understanding the factors contributing to these center-specific differences is crucial for improving outcomes in this vulnerable population.

Purpose of the Study:

  • To investigate the association between center-level intervention rates and mortality outcomes in ELBW infants.
  • To determine if patient-level risk factors and center intervention practices explain variations in mortality across different neonatal centers.

Main Methods:

  • Analysis of data from 5418 ELBW infants across 16 Neonatal Research Network centers (2006-2009).
  • Multilevel hierarchical models used to assess early (≤12 hours) and in-hospital mortality.
  • Models adjusted for patient risk factors and examined the impact of center intervention rates, stratified by gestational age (GA) <25 weeks and ≥25 weeks.

Main Results:

  • Wide ranges in early (5-36%) and in-hospital (11-53%) mortality rates were observed across centers for all GAs.
  • Center intervention rates significantly predicted mortality for infants with GA <25 weeks, but not for those with GA ≥25 weeks.
  • While center interventions and patient risk factors explained some variation in mortality, a significant portion remained unexplained, especially for infants with GA ≥25 weeks.

Conclusions:

  • Center intervention rates account for a portion of mortality variation, particularly for very preterm infants (GA <25 weeks), suggesting potential for improved outcomes through care standardization.
  • Observed mortality differences are not fully explained by patient characteristics or center intervention rates, indicating other unmeasured factors influence outcomes.
  • For infants with GA ≥25 weeks, patient factors and intervention rates explain only a small fraction of the center-level mortality variation.
Abstract

Keywords:
NICUextremely preterm infantsmortality ratesoutcomepreterm infants

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