Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

Brandon W Alleman; Edward F Bell; Lei Li; John M Dagle; P. Brian Smith; Namasivayam Ambalavanan; Matthew M Laughon; Barbara J Stoll; Ronald N Goldberg; Waldemar A Carlo; Jeffrey C Murray; C. Michael Cotten; Seetha Shankaran; Michele C Walsh; Abbot R Laptook; Dan L Ellsbury; Ellen C Hale; Nancy S Newman; Dennis D Wallace; Abhik Das; Rosemary D Higgins

doi:10.1542/peds.2012-3707

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Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

Journal article

Open access

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Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

Brandon W Alleman, Edward F Bell, Lei Li, John M Dagle, P. Brian Smith, Namasivayam Ambalavanan, Matthew M Laughon, Barbara J Stoll, Ronald N Goldberg, Waldemar A Carlo, …

Pediatrics (Evanston), Vol.132(1), pp.e175-e184

07/2013

DOI: 10.1542/peds.2012-3707

PMCID: PMC3691533

PMID: 23753096

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Abstract

OBJECTIVE: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants. METHODS: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006–2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs <25 weeks and ≥25 weeks. RESULTS: Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs <25 weeks, and 1% to 11% and 7% to 26% for GAs ≥25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants <25 weeks. For infants ≥25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates. CONCLUSIONS: Center intervention rates explain a portion of the center variation in mortality, especially for infants born at <25 weeks’ GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA ≥25 weeks these differences account for only a small part of the variation in mortality.

NICU

preterm infants

extremely preterm infants

outcome

mortality rates

Details

Title: Subtitle: Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants
Creators: Brandon W Alleman - Department of Pediatrics, University of Iowa, Iowa City, Iowa
Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City, Iowa
Lei Li - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
John M Dagle - Department of Pediatrics, University of Iowa, Iowa City, Iowa
P. Brian Smith - Department of Pediatrics, Duke University, Durham, North Carolina
Namasivayam Ambalavanan - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Matthew M Laughon - Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Barbara J Stoll - Department of Pediatrics, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, Georgia
Ronald N Goldberg - Department of Pediatrics, Duke University, Durham, North Carolina
Waldemar A Carlo - Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
Jeffrey C Murray - Department of Pediatrics, University of Iowa, Iowa City, Iowa
C. Michael Cotten - Department of Pediatrics, Duke University, Durham, North Carolina
Seetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, Michigan
Michele C Walsh - Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
Abbot R Laptook - Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island
Dan L Ellsbury - Center for Research, Education, and Quality, Pediatrix Medical Group, Sunrise, Florida
Ellen C Hale - Department of Pediatrics, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, Georgia
Nancy S Newman - Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
Dennis D Wallace - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
Abhik Das - Statistics and Epidemiology Unit, RTI International, Rockville, Maryland; and
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.132(1), pp.e175-e184
DOI: 10.1542/peds.2012-3707
PMID: 23753096
PMCID: PMC3691533
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Publisher: American Academy of Pediatrics; Elk Grove Village, IL, USA
Language: English
Date published: 07/2013
Academic Unit: Anatomy and Cell Biology; Stead Family Department of Pediatrics; Epidemiology; Pediatric Dentistry; Craniofacial Anomalies Research Center; Biochemistry and Molecular Biology; Dental Research; Neonatology
Record Identifier: 9984024567602771

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