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High-level, high-volume centers linked to lower mortality in VLBW infants
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Very low-birth-weight infants not born in high-level, high-volume centers had poorer outcomes than their peers born in such centers, according to study findings published in JAMA Pediatrics.
Zachary J. Kastenberg, MD, of Stanford University School of Medicine in Stanford, Calif., and colleagues assessed outcomes data among very low-birth-weight (VLBW) infants collected from the California Perinatal Quality Care Collaborative between 2005 and 2011. More than 90% of perinatal facilities in California submitted clinical data to the collaborative.
Zachary J. Kastenberg
There were approximately 3 million live births in California during the study period. Of these, 30,566 were VLBW infants, of whom 6.1% (n=1,879) developed necrotizing enterocolitis, according to the researchers.
Overall, unadjusted mortality rates were 9.8% for VLBW infants without necrotizing enterocolitis and 21.9% for those with necrotizing enterocolitis.
VLBW infants born in level IIIB/IIIC high-volume neonatal ICUs had higher rates of comorbidities and maternal risk factors, but a significantly lower unadjusted mortality rate compared with those born in lower-level neonatal ICUs.
VLBW infants with necrotizing enterocolitis born in level II neonatal ICUs had similar unadjusted mortality rates as those born in level IIIB/IIIC high-volume neonatal ICUs (17.6% vs. 20.4%). However, those born in level IIIA and IIIB low-volume neonatal ICUs had significantly increased mortality rates, 22.3% and 24.6%, respectively.
When adjusting for infant and maternal characteristics, odds for mortality among all VLBW infants born in level II, IIIA or IIIB low-volume centers increased by 21% to 34% compared with those born in level IIIB/IIIC high-volume centers.
Similarly, odds for mortality among VLBW infants without necrotizing enterocolitis born in level II, IIIA, or IIIB low-volume centers increased by 21% to 32% compared with those born in level IIIB/IIIC high-volume centers.
Further, odds for mortality among VLBW infants with necrotizing enterocolitis born in level IIIA or IIIB low-volume neonatal ICUs increased by 42% to 51% compared with those born in level IIIB/IIIC high-volume neonatal ICUs.
“Outcomes for VLBW infants continue to be suboptimal when they are not born into high-level, high-volume centers,” the researchers wrote. “In a dynamic period of continued deregionalization, the necrotizing enterocolitis population is a particularly high-risk subgroup of the VLBW population for whom regionalized neonatal intensive care will be beneficial.”
Disclosure: The researchers report no relevant financial disclosures.
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