Journal article
Between-hospital variation in treatment and outcomes in extremely preterm infants
The New England journal of medicine, Vol.372(19), pp.1801-1811
05/07/2015
DOI: 10.1056/NEJMoa1410689
PMCID: PMC4465092
PMID: 25946279
Abstract
Between-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth.
We studied infants born between April 2006 and March 2011 at 24 hospitals included in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Data were collected for 4987 infants born before 27 weeks of gestation without congenital anomalies. Active treatment was defined as any potentially lifesaving intervention administered after birth. Survival and neurodevelopmental impairment at 18 to 22 months of corrected age were assessed in 4704 children (94.3%).
Overall rates of active treatment ranged from 22.1% (interquartile range [IQR], 7.7 to 100) among infants born at 22 weeks of gestation to 99.8% (IQR, 100 to 100) among those born at 26 weeks of gestation. Overall rates of survival and survival without severe impairment ranged from 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks of gestation to 81.4% (IQR, 78.2 to 84.0) and 75.6% (IQR, 69.5 to 80.0), respectively, among those born at 26 weeks of gestation. Hospital rates of active treatment accounted for 78% and 75% of the between-hospital variation in survival and survival without severe impairment, respectively, among children born at 22 or 23 weeks of gestation, and accounted for 22% and 16%, respectively, among those born at 24 weeks of gestation, but the rates did not account for any of the variation in outcomes among those born at 25 or 26 weeks of gestation.
Differences in hospital practices regarding the initiation of active treatment in infants born at 22, 23, or 24 weeks of gestation explain some of the between-hospital variation in survival and survival without impairment among such patients. (Funded by the National Institutes of Health.).
Details
- Title: Subtitle
- Between-hospital variation in treatment and outcomes in extremely preterm infants
- Creators
- Matthew A Rysavy - From the Stead Family Department of Pediatrics (M.A.R., E.F.B., J.C.M., T.T.C., J.E.B.) and the Department of Epidemiology (M.A.R.), University of Iowa, Iowa City; the Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, NC (L.L.), and Rockville, MD (A.D.); Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA (S.R.H.); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.J.S.); Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); Department of Pediatrics, University of Alabama at Birmingham, Birmingham (W.A.C.); Department of Pediatrics, Wayne State University, Detroit (S.S.); Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland (M.C.W.); Department of Pediatrics, University of Texas Medical School at Houston, Houston (J.E.T.); Department of Pediatrics, Duke University, Durham, NC (C.M.C., P.B.S.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.)Lei LiEdward F BellAbhik DasSusan R HintzBarbara J StollBetty R VohrWaldemar A CarloSeetha ShankaranMichele C WalshJon E TysonC Michael CottenP Brian SmithJeffrey C MurrayTarah T ColaizyJane E BrumbaughRosemary D Higgins
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.372(19), pp.1801-1811
- DOI
- 10.1056/NEJMoa1410689
- PMID
- 25946279
- PMCID
- PMC4465092
- NLM abbreviation
- N Engl J Med
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Publisher
- United States
- Grant note
- U10 HD053124 / NICHD NIH HHS UG1 HD053089 / NICHD NIH HHS UG1 HD040492 / NICHD NIH HHS T32 GM007337 / NIGMS NIH HHS U10 HD027871 / NICHD NIH HHS U10 HD053119 / NICHD NIH HHS UG1 HD027880 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS UL1 TR000371 / NCATS NIH HHS UG1 HD021385 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS U01 HD036790 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS UG1 HD021364 / NICHD NIH HHS
- Language
- English
- Date published
- 05/07/2015
- Academic Unit
- Anatomy and Cell Biology; Stead Family Department of Pediatrics; Epidemiology; Pediatric Dentistry; Craniofacial Anomalies Research Center; Dental Research; Neonatology
- Record Identifier
- 9984025310302771
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