The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants

Chung, Judith H.; Phibbs, Ciaran S.; Boscardin, W. John; Kominski, Gerald F.; Ortega, Alexander N.; Needleman, Jack

doi:10.1097/mlr.0b013e3181dbe887

Cited by 99 publications

(102 citation statements)

References 32 publications

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“…[1][2][3]5,10 First, the majority of these studies evaluated hospital level of care alone on the risk of perinatal mortality and did not account for confounding by hospital site of delivery. 3,5,10 Two of the more recent studies, both of which were performed by members of our group, have evaluated the effect of hospital level of care and hospital volume on mortality of very low birth weight infants by disaggregating these factors, treating them as fixed effects at the individual level, and then using traditional, individual level statistical tools for the analyses.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Year of delivery was also included, as we have noted a general trend toward improved outcomes with advancing year. 1,2 As in our previous studies, the primary outcome of very low birth weight death was defined as in-hospital fetal deaths, deaths within the first 28 days of life and deaths within the first year of life among infants who were continually hospitalized from birth. 1,2 This is because standard definition of neonatal death (death within the first 28 days of life) may be biased.…”

Section: Methodsmentioning

confidence: 99%

“…This data set was used in a previous study by our group, and specific details on the data preparation can be obtained in the publication of that work. 1 In brief, data from deliveries occurring in the state of California from 1 January 1997 to 31 December 2002 were available for analysis and were limited to singleton, very low birth weight neonates between 500 to 1499 gm. Neonates weighing <500 gm were excluded from the study, because there may be differences in whether such infants receive medical interventions after birth by their medical provider and/or hospital site of delivery.…”

Section: Methodsmentioning

confidence: 99%

“…1 In the aforementioned study, traditional, individual-level statistics (i.e., logistic regression) were used to examine the effect of hospital level of care and hospital volume on the odds of very low birth weight mortality, after adjusting for differences in case-mix by hospital site of delivery. 1 As a consequence of the statistical methodology used in that study, both individual-and hospital-level characteristics were analyzed at a single level, rather than in a hierarchical manner, and treatment of the data in that manner may have led to an overestimation of the true effect of the hospital level and volume on the outcome of mortality. 7 Conversely, the technique of hierarchical generalized linear modeling, also known as multilevel modeling, is applied in the present study, to account for the hierarchical nature of the data (infants delivered within hospitals).…”

Section: Methodsmentioning

confidence: 99%

“…1,2 However, owing to the increased availability of technology and trained personnel, there has been a dissemination of specialty perinatal and neonatal services beyond large, centralized academic centers. [3][4][5] In California, this trend has manifested as an increased number of midlevel neonatal intensive care units.…”

Section: Introductionmentioning

confidence: 99%

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Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

et al. 2011

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Objective: The objective of this study was to examine the effect of hospitallevel factors on mortality of very low birth weight infants using multilevel modeling.Study Design: This is a secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002. The study population was limited to singleton, non-anomalous, very low birth weight infants, who delivered in hospitals providing neonatal intensive care services (level-2 and higher). Hierarchical generalized linear modeling, also known as multilevel modeling, was used to adjust for individual-level confounders.Result: In a multilevel model, increasing hospital volume of very low birth weight deliveries was associated with lower odds of very low birth weight mortality. Characteristics of a particular hospital's obstetrical and neonatal services (the presence of residency and fellowship training programs and the availability of perinatal and neonatal services) had no independent effect. Conclusion: Using multilevel modeling, hospital volume of very low birth weight deliveries appears to be the primary driver of reduced mortality among very low birth weight infants.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

et al. 2011

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Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks’ Gestation, 2009-2020

et al. 2023

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ImportanceIn an ideal regionalized system, all infants born very preterm would be delivered at a large tertiary hospital capable of providing all necessary care.ObjectiveTo examine whether the distribution of extremely preterm births changed between 2009 and 2020 based on neonatal intensive care resources at the delivery hospital.Design, Setting, and ParticipantsThis retrospective cohort study was conducted at 822 Vermont Oxford Network (VON) centers in the US between 2009 and 2020. Participants included infants born at 22 to 29 weeks’ gestation, delivered at or transferred to centers participating in the VON. Data were analyzed from February to December 2022.ExposuresHospital of birth at 22 to 29 weeks’ gestation.Main Outcomes and MeasuresBirthplace neonatal intensive care unit (NICU) level was classified as A, restriction on assisted ventilation or no surgery; B, major surgery; or C, cardiac surgery requiring bypass. Level B centers were further divided into low-volume (&lt;50 inborn infants at 22 to 29 weeks’ gestation per year) and high-volume (≥50 inborn infants at 22 to 29 weeks’ gestation per year) centers. High-volume level B and level C centers were combined, resulting in 3 distinct NICU categories: level A, low-volume B, and high-volume B and C NICUs. The main outcome was the change in the percentage of births at hospitals with level A, low-volume B, and high-volume B or C NICUs overall and by US Census region.ResultsA total of 357 181 infants (mean [SD] gestational age, 26.4 [2.1] weeks; 188 761 [52.9%] male) were included in the analysis. Across regions, the Pacific (20 239 births [38.3%]) had the lowest while the South Atlantic (48 348 births [62.7%]) had the highest percentage of births at a hospital with a high-volume B– or C-level NICU. Births at hospitals with A-level NICUs increased by 5.6% (95% CI, 4.3% to 7.0%), and births at low-volume B–level NICUs increased by 3.6% (95% CI, 2.1% to 5.0%), while births at hospitals with high-volume B– or C-level NICUs decreased by 9.2% (95% CI, −10.3% to −8.1%). By 2020, less than half of the births for infants at 22 to 29 weeks’ gestation occurred at hospitals with high-volume B– or C-level NICUs. Most US Census regions followed the nationwide trends; for example, births at hospitals with high-volume B– or C-level NICUs decreased by 10.9% [95% CI, −14.0% to −7.8%) in the East North Central region and by 21.1% (95% CI, −24.0% to −18.2%) in the West South Central region.Conclusions and RelevanceThis retrospective cohort study identified concerning deregionalization trends in birthplace hospital level of care for infants born at 22 to 29 weeks’ gestation. These findings should serve to encourage policy makers to identify and enforce strategies to ensure that infants at the highest risk of adverse outcomes are born at the hospitals where they have the best chances to attain optimal outcomes.

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Epidemiologic Trends in Neonatal Intensive Care, 2007-2012

2015

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IMPORTANCE Neonatal intensive care has been highly effective at improving newborn outcomes but is expensive and carries inherent risks. Existing studies of neonatal intensive care have focused on specific subsets of newborns and lack a population-based perspective. OBJECTIVES To describe admission rates to neonatal intensive care units (NICUs) for US newborns across the entire continuum of birth weight and how these rates have changed across time, as well as describe the characteristics of infants admitted to NICUs.

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The Effect of Neonatal Intensive Care Level and Hospital Volume on Mortality of Very Low Birth Weight Infants

Abstract: Although deregionalization of perinatal services may increase access to care for high-risk mothers and newborns, its impact on hospital volume may outweigh its potential benefit.

Cited by 99 publications

References 32 publications

Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling

Trends in Resources for Neonatal Intensive Care at Delivery Hospitals for Infants Born Younger Than 30 Weeks’ Gestation, 2009-2020

Epidemiologic Trends in Neonatal Intensive Care, 2007-2012

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