The importance of understanding hospital and country-specific case-mix for neonatal patients

Abstract

The study by Grandi et al. provides important information about the prevalence and impact of maternal diabetes mellitus on the outcomes of very low birth weight infants in South American neonatal intensive care units (NICUs). They report an overall rate of maternal diabetes of 2.8%, with an increase in prevalence from 2001-2005 of 2.4% to 3.2% over the period between 2006-2010. Also, of the numerous perinatal and neonatal outcomes examined in this cohort of almost 12,000 infants, only severe necrotizing enterocolitis was associated with diabetes mellitus in multivariable regression. 1 These data differ from other published results. Prior studies of the prevalence of gestational diabetes range from an estimated 2-6% of cases across European countries, 2 5-11% within 15 states of the US, 3 and 16% in Qatar. 4 Several studies from both low-and middle-income countries 5 and developed countries 6 also show diabetes as a risk factor DOI of original article: http://dx.doi.org/10.1016/j.jped.2014.08.007 ଝ Please cite this article as: Lorch SA. The importance of understanding hospital and country-specific case-mix for neonatal patients. J Pediatr (Rio J). 2015;91:207---9. for adverse pregnancy and neonatal outcomes, albeit in the entire population versus a specific, high-risk population such as that studied by Grandi et al. 1 What do these findings, or any similar findings, mean for the clinicians or policy makers overseeing the care delivered to high-risk newborns, especially in light of data suggesting that rates of gestational diabetes in other countries is increasing? 7 Practitioners should assess the validity of the results and then determine the potential impact of these results on their practice.For any study, we should examine whether the data are accurate before any actions are undertaken. Inaccuracies can occur in three major areas: 2 could the diagnosis be made in all women; was the diagnostic test appropriate; and were the data collected on each pregnancy correct. For a condition such as gestational diabetes, women must both receive prenatal care, and have the test to confirm either the presence or absence of the condition. Depending on the hospital, health system, or country's population and social dynamics, access to prenatal care or to the tools needed to make the diagnosis may be limited. Additionally, for diabetes, one standard diagnostic procedure is a 1-or 3-hour glucose test, administered typically at 24-28 weeks gestation. It is not clear what percentage of women who delivered before 28 weeks gestation could have had the diagnosis. These two http://dx.