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High-volume neonatal units reduced preterm infants’ risk for mortality
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Recent data show very preterm infants who received neonatal care in high-volume neonatal units in England had lower risk for mortality compared with those who received care in tertiary-level neonatal units.
Samuel Watson, a PhD student at the University of Warwick in Oxford, UK, and colleagues assessed electronic records from the National Neonatal Research Database of infants admitted to 168 neonatal units in England between January 2009 and December 2011. Researchers enrolled infants with a gestational age of 32 weeks and less (n=20,554). Of those, 2,559 had a gestational age of 26 weeks and less.
About half of the study cohort was born in hospitals with a tertiary-level neonatal unit (n=9,466; 46.1%) and 9,541 were born in hospitals with a high-volume neonatal unit.
Infants were born in 165 hospitals, of which 44 had level 3 neonatal units, 81 had level 2 neonatal units, and 39 had level 1 neonatal units. Thirty-nine neonatal units were classified as high-volume, of which 30 were considered level 3 units. Fourteen of the 44 level 3 units were not considered high-volume.
Analysis did not indicate a significant difference in the overall risk of mortality for very preterm infants admitted to tertiary level care and those admitted to non-tertiary level care. However, infants born at 26 weeks gestation and less had a reduced overall risk for neonatal mortality (OR=0.65; 95% CI, 0.46-0.91, P=0.012) but no significant differences regarding in-hospital mortality.
Infants admitted to high-volume neonatal units had a reduced overall risk for neonatal mortality of 0.73 (95% CI, 0.56-0.95). Of these, infants with a gestational age of 26 weeks and less had a reduced overall risk for neonatal mortality (OR=0.62; 95% CI, 0.44-0.87) and for in-hospital mortality (OR=0.71; 95% CI, 0.52-0.97). Infants with a gestational age of 26 weeks and less had an increased overall risk for bronchopulmonary dysplasia of 1.59 (95% CI, 1.18-2.14).
Infants born at 27 to 32 weeks gestation in a hospital with a tertiary-level unit had an increased risk for treatment of retinopathy of prematurity (OR=2.17; 95% CI, 1.06-4.47).
Admission to a high-volume neonatal unit significantly reduced overall risk for neonatal mortality (OR=0.70; 95% CI, 0.53-0.92) and any in-hospital mortality (OR=0.68; 95% CI, 0.54-0.85) among very preterm infants. These effects were most acute among infants with a gestational age of 26 weeks and less.
“We provide evidence of reduced overall risk or mortality for very preterm infants admitted to high-volume neonatal units at delivery hospitals. The effect of volume on neonatal outcomes is an important consideration for policy makers deciding the optimal organization of neonatal specialist services,” the researchers concluded.
Disclosure: The researchers have financial ties with Bliss, the Department of Health’s NIHR Biomedical Research Centre, and the NESCOP group.
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