Title | Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis. |
Publication Type | Journal Article |
Year of Publication | 2015 |
Authors | Kastenberg ZJ, Lee HC, Profit J, Gould JB, Sylvester KG |
Journal | JAMA Pediatr |
Volume | 169 |
Issue | 1 |
Pagination | 26-32 |
Date Published | 2015 Jan |
ISSN | 2168-6211 |
Keywords | California, Enterocolitis, Necrotizing, Female, Hospital Mortality, Humans, Infant, Infant Mortality, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Intensive Care, Neonatal, Male, Retrospective Studies, Risk Factors, Treatment Outcome |
Abstract | IMPORTANCE: There has been a significant expansion in the number of low-level and midlevel neonatal intensive care units (NICUs) in recent decades. Infants with necrotizing enterocolitis represent a high-risk subgroup of the very low-birth-weight (VLBW) (<1500 g) population that would benefit from focused regionalization. OBJECTIVES: To describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted of NICUs in California. We used data collected by the California Perinatal Quality Care Collaborative from 2005 to 2011 to assess mortality rates among a population-based sample of 30 566 VLBW infants, 1879 with necrotizing enterocolitis, according to the level of care and VLBW case volume at the hospital of birth. EXPOSURES: Level and volume of neonatal intensive care at the hospital of birth. MAIN OUTCOMES AND MEASURES: In-hospital mortality. RESULTS: There was a persistent trend toward deregionalization during the study period and mortality rates varied according to the level of care. High-level, high-volume (level IIIB with >100 VLBW cases per year and level IIIC) hospitals achieved the lowest risk-adjusted mortality. Infants with necrotizing enterocolitis born into midlevel hospitals (low-volume level IIIB and level IIIA NICUs) had odds of death ranging from 1.42 (95% CI, 1.08-1.87) to 1.51 (95% CI, 1.05-2.15, respectively). In the final year of the study, just 28.6% of the infants with necrotizing enterocolitis were born into high-level, high-volume hospitals. For infants born into lower level centers, transfer to a higher level of care frequently occurred well into the third week of life. CONCLUSIONS AND RELEVANCE: These findings represent an immediate opportunity for local quality improvement initiatives and potential impetus for the regionalization of important NICU resources. |
DOI | 10.1001/jamapediatrics.2014.2085 |
Alternate Journal | JAMA Pediatr |
PubMed ID | 25383940 |
Grant List | HS000028 / HS / AHRQ HHS / United States UL1 RR025744 / RR / NCRR NIH HHS / United States |