Moderate, late preterm infants may receive better care at smaller NICUs
Moderate and late preterm infants may receive better care at NICUs with fewer complex services, according to a study published in JAMA Pediatrics.
Researchers said the finding “has broad implications for the organization and structure of neonatal care delivery.”
Most NICUs have differing types of resources for infants with different care needs, including general care for well or less ill infants and subspecialized medical and surgical care for more ill infants, according to co-authors Sara C. Handley, MD, MSCE, and Elizabeth G. Salazar, MD, neonatologists at The Children’s Hospital of Philadelphia.
“Much research in neonatology has shown that the smallest, most preterm infants receive the best care and have the best outcomes at more subspecialized centers. Yet, the majority of infants that receive care in the NICU are bigger, less preterm infants,” they told Healio in a joint email response.
“As a group interested in optimizing patient care and improving outcomes, we wondered where these bigger, less preterm infants received the highest quality of care,” they wrote. “We suspected that these less preterm infants may receive better care at general NICUs with lower patient acuity and more resources relevant to their degree of prematurity.”
Using the Vermont Oxford Network, an international NICU quality collaborative comprising 465 U.S. hospitals, Handley, Salazar and colleagues identified separate groups of infants — 376,219 moderate or late preterm infants born between 30 and 36 weeks of gestation, and 57,595 extremely or very preterm infants born between 25 and 29 weeks of gestation.
The researchers assessed the quality of care for each group of infants using a previously reported quality score, which incorporated multiple aspects of infant care and accounted for patient-level variables to address differences in severity of illness.
They examined differences in quality scores in four types of NICUs: type A with restrictions, meaning units with ventilation restrictions without surgery; type A, similar units but with surgery; type B, with surgery not requiring cardiac bypass; and type C, with all surgery.
Ultimately, among all included infants, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs and 24.4% in type C NICUs.
“We found that quality scores in moderate and late preterm infants were lower in the most resourced, subspecialized NICUs, but that this was not the case for extremely and very preterm infants,” they wrote. “Many of the differences we observed in moderate and late preterm infants by NICU type appeared to be due to differences in length of stay and infant weight gain.”
“Many assume that more resources ensure a higher quality of care. It was surprising to find that for moderate and late preterm infants, this may not be the case,” they continued. “It leads us to wonder if lower acuity patients may be better served in a hospital with fewer extremely sick patients and resources that more closely align with their specific needs.”
Handley and Salazar added that further investigation will be necessary to understand these results.
“While replication of these results will be valuable, as this is a new finding, the pediatric community needs to understand more about why we observed this pattern,” they wrote.