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Variability in 28-day outcomes for very low birth weight infants: an analysis of 11 neonatal intensive care units
J D Horbar1, T L McAuliffe, S M Adler
1Department of Pediatrics, University of Vermont, Burlington.
Insights
Neonatal intensive care centers showed significant variation in 28-day survival and survival without supplemental oxygen for premature infants. Factors like female gender, nonwhite race, and higher birth weight improved outcomes.
Area of Science:
- Neonatology
- Pediatric Critical Care
- Public Health
Background:
- Premature infants born weighing 701 to 1,500 grams face significant health challenges.
- Outcomes for these vulnerable infants can vary based on the neonatal intensive care center.
- Survival and absence of chronic lung disease are key indicators of neonatal care quality.
Purpose of the Study:
- To determine if 28-day survival rates differ among neonatal intensive care centers.
- To assess variations in survival without supplemental oxygen (indicating no chronic lung disease) across centers.
- To identify factors influencing these outcomes in premature infants.
Main Methods:
- Retrospective study of 1,776 infants born between 701 and 1,500 grams across 11 centers.
- Analysis of 28-day survival and 28-day survival without supplemental oxygen.
- Multivariate analysis to account for birth weight, gender, and race.
Main Results:
- Overall 28-day survival was 85% (range 80-92% by center).
- 60% survived 28 days without supplemental oxygen (range 51-70% by center).
- Significant center variation existed for both outcomes, even after adjusting for covariates. Female gender, nonwhite race, and increased birth weight were associated with better outcomes.
Conclusions:
- Significant disparities in neonatal intensive care outcomes exist among centers.
- Standardized care protocols may be necessary to reduce outcome variation.
- Further research into center-specific practices influencing survival and respiratory health is warranted.
Abstract:
A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period. Of these infants, 85% (1,512) survived 28 days, a range of 80% to 92% at the individual centers. A total of 60% (1,056) of the infants were alive without supplemental oxygen on day 28, a range of 51% to 70% at the individual centers. Multivariate analysis demonstrated that both survival on day 28 (chi 2 = 23.9, P less than .01) and survival without supplemental oxygen on day 28 (chi 2 = 44.2, P less than .0001) varied significantly among centers after the effects of birth weight, gender, and race were taken into account. Female gender, nonwhite race, and increased birth weight were factors associated with improved rates of survival and survival without supplemental oxygen. The magnitude of outcome variation among centers was estimated by using the logistic regression models to predict what the outcomes would be if each center were to treat a standardized population consisting of all 1,776 study infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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