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The Effect of Level of Care on Gastroschisis Outcomes
Jordan C Apfeld1, Zachary J Kastenberg2, Karl G Sylvester3
1Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
Objective:
To examine the relationship between level of care in neonatal intensive care units (NICUs) and outcomes for newborns with gastroschisis.
Study Design:
A retrospective cohort study was conducted at 130 California Perinatal Quality Care Collaborative NICUs from 2008 to 2014. All gastroschisis births were examined according to American Academy of Pediatrics NICU level of care at the birth hospital. Multivariate analyses examined odds of mortality, duration of mechanical ventilation, and duration of stay.
Results:
For 1588 newborns with gastroschisis, the adjusted odds of death were higher for those born into a center with a level IIA/B NICU (OR, 6.66; P = .004), a level IIIA NICU (OR, 5.95; P = .008), or a level IIIB NICU (OR, 5.85; P = .002), when compared with level IIIC centers. The odds of having more days on ventilation were significantly higher for births at IIA/B and IIIB centers (OR, 2.05 [P < .001] and OR, 1.91 [P < .001], respectively). The odds of having longer duration of stay were significantly higher at IIA/B and IIIB centers (OR, 1.71 [P < .004]; OR, 1.77 [P < .001]).
Conclusions:
NICU level of care was associated with significant disparities in odds of mortality for newborns with gastroschisis.
