Journal article
Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants
Obstetrical & gynecological survey, Vol.70(9), pp.549-551
09/2015
DOI: 10.1097/01.ogx.0000471596.46762.bf
Abstract
ABSTRACTWhen an infant is born near the limit of viability, clinicians face difficulties in determining whether active treatment is in the patient’s best interest. The outcomes for extremely preterm birth vary widely. The aim of this study was to investigate whether that variation may reflect differences between hospitals in the decision to actively treat neonates versus provide comfort care.Data were collected from 24 hospitals in the United States between April 1, 2006, and March 31, 2011, for infants born before 27 weeks’ gestation. Active treatment was defined by a number of treatments but did not include obstetrical treatment or consider later decisions to withdraw treatment, as this study focused on the decision to initiate active treatment. Outcomes included survival, survival without severe impairment, and survival without moderate or severe impairment. At 18 to 22 months corrected age, data on neurodevelopmental impairment and survival were collected. Multivariable multilevel logistic regression models were used for statistical analysis.Of the 4987 infants included in the study, 4329 (86.8%) received active treatment. Of infants born at 22 weeks’ gestation, 22.1% received active treatment (95% confidence interval [CI], 18.1%–26.8%). At 23 weeks, 71.8% received treatment (95% CI, 68.5%–74.9%); 97.1% (95% CI, 96.0%–98.0%) received treatment at 24 weeks, 99.6% (95% CI, 99.1%–99.8%) born at 25 weeks; and 99.8% (95% CI, 99.4%–100.0%) born at 26 weeks. Of those who received treatment with known outcomes (n = 4046), 65% survived, 56.1% survived without severe neurodevelopmental impairment, and 40.8% survived without moderate or severe neurodevelopmental impairment. Hospital rates of active treatment varied widely in infants born at 22 to 24 weeks. At 23 weeks’ gestation, interquartile range for active treatment rates in hospitals ranged from 52.5% to 96.5%. The initiation of active treatment clustered at the hospital level, according to multilevel models. Hospital rates of active treatment did not account for any variation in outcomes among infants born at 25 or 26 weeks’ gestation, but did account for 78% and 75% of the variation in survival and survival without severe impairment in children born at 22 or 23 weeks’ gestation, and also accounted for 22% and 16% for infants born at 24 weeks.Some of the between-hospital variation in survival and impairment rates among infants can be explained by between-hospital differences in the practice of initiating active treatment in infants born between 22 and 24 weeks.
Details
- Title: Subtitle
- Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants
- Creators
- Matthew RysavyLei LiEdward BellAbhik DasSusan HintzBarbara StollBetty VohrWaldemar CarloSeetha ShankaranMichele WalshJon TysonC CottenP SmithJeffrey MurrayTarah ColaizyJane BrumbaughRosemary Higgins
- Resource Type
- Journal article
- Publication Details
- Obstetrical & gynecological survey, Vol.70(9), pp.549-551
- DOI
- 10.1097/01.ogx.0000471596.46762.bf
- ISSN
- 0029-7828
- eISSN
- 1533-9866
- Publisher
- Wolters Kluwer Health, Inc.
- Language
- English
- Date published
- 09/2015
- Academic Unit
- Anatomy and Cell Biology; Stead Family Department of Pediatrics; Epidemiology; Pediatric Dentistry; Craniofacial Anomalies Research Center; Dental Research; Neonatology
- Record Identifier
- 9984025697102771
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