Levels of Neonatal Care

Stark, Ann R.

doi:10.1542/peds.2004-1697

Cited by 328 publications

(86 citation statements)

References 43 publications

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“…For inborn and outborn definitions, level III units in each network are equivalent to level IIIb and level IIIc centers as defined by the American Academy Of Pediatrics [12]. While the tertiary center facilities of each country are very similar, Canada has advanced level II nursery units, where moderately preterm neonates are taken care of.…”

Section: Methodsmentioning

confidence: 99%

Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada

Hossain

Shah²,

Ye³

et al. 2015

Neonatology

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Background: Very preterm infants born outside tertiary centers are at higher risks of adverse outcomes than inborn infants. Regionalization of perinatal care has been introduced worldwide to improve outcomes. Objective: To compare the risk-adjusted outcomes of both inborn and outborn infants cared for in tertiary neonatal intensive care units in Australia and New Zealand and in Canada. Methods: Deidentified data of infants <32 weeks' gestational age from the 29 Australian and New Zealand Neonatal Network units (ANZNN; n = 9,893) and 26 Canadian Neonatal Network units (CNN; n = 7,133) between 2005 and 2007 were analyzed for predischarge adverse outcomes. Results: ANZNN had lower rates of outborns compared to CNN (13 vs. 19%), particularly of late admissions (>2 days of age; 5.8 vs. 22.2% of outborns) who had high morbidity rates. After adjusting for confounding variables including gestation, ANZNN inborn infants had lower odds of chronic lung disease [CLD; 17.0 vs. 23.3%; adjusted odds ratio (AOR) = 0.70, 95% CI: 0.64-0.77], severe neurological injuries on ultrasound (SNI; 4.1 vs. 6.7%; AOR = 0.62, 95% CI: 0.53-0.73), severe retinopathy (5.6 vs. 7%; AOR = 0.71, 95% CI: 0.59-0.84) and necrotizing enterocolitis (3.5 vs. 5.4%; AOR = 0.67, 95% CI: 0.56-0.79), but no difference in mortality odds. After excluding the late outborn admissions, ANZNN outborns had lower odds of SNI (AOR = 0.43, 95% CI: 0.32-0.58) and CLD (AOR = 0.63, 95% CI: 0.49-0.81) than CNN. Conclusions: ANZNN inborn and early admitted outborn infants had lower odds of neonatal morbidities than their CNN counterparts. However, compared to ANZNN, the higher CNN rates of outborns and their late admissions are likely related to the differences in regionalization and referral practices, and may explain differences in outcomes.

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Section: Methodsmentioning

confidence: 99%

Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada

Hossain

Shah²,

Ye³

et al. 2015

Neonatology

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“…Multiple admissions were assessed as one hospitalization if an infant was admitted to a hospital on the same day as discharged from a previous admission, or if the infant was admitted to a hospital one day after a previous discharge with an accompanying “transfer” code. The level of birth hospitalization nursery care (I, III, or III [highest]) (American Academy of Pediatrics, 2004) that an infant received was coded as the highest facility level if a transfer occurred. Infants’ hospital discharge records identified the principal expected healthcare payer for each hospitalization as private or employer-based insurance (including TRICARE) or public insurance (Medicare, Medicaid, Veteran’s Administration, and Children’s Health Insurance Program, which is KidCare in Florida).…”

Section: Methodsmentioning

confidence: 99%

“…Multiple admission records were merged into one if an infant was admitted to a hospital on the same day as a discharge from a previous admission, or if the infant was admitted to a hospital on the day after a previous discharge with an accompanying “transfer” code. The level of birth hospitalization nursery care (I, III, or III [highest])]) (American Academy of Pediatrics Committee on Fetus and Newborn, 2004) that an infant received was coded as the highest facility level if a transfer occurred. c p <0.05 for test of timely versus late detection (Mann-Whitney-Wilcoxon rank sum test). d Conditions identified as primary targets for pulse oximetry screening (Mahle et al, 2009; Kemper et al, 2011). …”

Section: Tablementioning

confidence: 99%

Hospitalizations, costs, and mortality among infants with critical congenital heart disease: How important is timely detection?

Peterson

Dawson

Grosse

et al. 2013

Birth Defects Research

103

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BACKGROUND Critical congenital heart disease (CCHD) was recently added to the U.S. Recommended Uniform Screening Panel for newborns. States considering screening requirements may want more information about the potential impact of screening. This study examined potentially avoidable mortality among infants with late detected CCHD and assessed whether late detection was associated with increased hospital resource use during infancy. METHODS This was a state-wide, population-based, observational study of infants with CCHD (n =3603) born 1998 to 2007 identified by the Florida Birth Defects Registry. We examined 12 CCHD conditions that are targets of newborn screening. Late detection was defined as CCHD diagnosis after the birth hospitalization. Deaths potentially avoidable through screening were defined as those that occurred outside a hospital following birth hospitalization discharge and those that occurred within 3 days of an emergency readmission. RESULTS For 23% (n =825) of infants, CCHD was not detected during the birth hospitalization. Death occurred among 20% (n =568/2,778) of infants with timely detected CCHD and 8% (n =66/825) of infants with late detected CCHD, unadjusted for clinical characteristics. Potentially preventable deaths occurred in 1.8% (n =15/825) of infants with late detected CCHD (0.4% of all infants with CCHD). In multivariable models adjusted for selected characteristics, late CCHD detection was significantly associated with 52% more admissions, 18% more hospitalized days, and 35% higher inpatient costs during infancy. CONCLUSION Increased CCHD detection at birth hospitals through screening may lead to decreased hospital costs and avoid some deaths during infancy. Additional studies conducted after screening implementation are needed to confirm these findings.

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“…Of these centers, 15 are designated as level IIID on the basis of open-heart surgery performance, and the remainder are designated as level IIIC. 23 We used multiyear analysis because of the few very low-birth-weight infants cared for in some institutions. Detailed descriptions of measure selection, definition, and exclusion criteria have been published elsewhere 21 and are summarized in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

Profit¹,

Zupancic²,

Gould³

et al. 2013

JAMA Pediatr

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Objectives To examine whether high performance on one measure of quality is associated with high performance on others and to develop a data-driven explanatory model of neonatal intensive care unit (NICU) performance. Design We conducted a cross-sectional data analysis of a statewide perinatal care database. Risk-adjusted NICU ranks were computed for each of 8 measures of quality selected based on expert input. Correlations across measures were tested using the Pearson correlation coefficient. Exploratory factor analysis was used to determine whether underlying factors were driving the correlations. Setting Twenty-two regional NICUs in California. Patients In total, 5445 very low-birth-weight infants cared for between January 1, 2004, and December 31, 2007. Main Outcomes Measures Pneumothorax, growth velocity, health care–associated infection, antenatal corticosteroid use, hypothermia during the first hour of life, chronic lung disease, mortality in the NICU, and discharge on any human breast milk. Results The NICUs varied substantially in their clinical performance across measures of quality. Of 28 unit-level correlations only 6 were significant (P < .05). Correlations between pairs of quality measures were strong (ρ > .5) for 1 pair, moderate (.3 < |ρ| < .5) for 8 pairs, weak (.1 < |ρ| < .3) for 5 pairs and negligible (|ρ| < .1) for 14 pairs. Exploratory factor analysis revealed 4 underlying factors of quality in this sample. Pneumothorax, mortality in the NICU, and antenatal corticosteroid use loaded on factor 1; growth velocity and health care–associated infection loaded on factor 2; chronic lung disease loaded on factor 3; and discharge on any human breast milk loaded on factor 4. Conclusion In this sample, the ability of individual measures of quality to explain overall quality of neonatal intensive care was modest.

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Levels of Neonatal Care

Cited by 328 publications

References 43 publications

Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada

Outborns or Inborns: Where Are the Differences? A Comparison Study of Very Preterm Neonatal Intensive Care Unit Infants Cared for in Australia and New Zealand and in Canada

Hospitalizations, costs, and mortality among infants with critical congenital heart disease: How important is timely detection?

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

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