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Comparative Study
. 2013 Jul;132(1):e175-84.
doi: 10.1542/peds.2012-3707. Epub 2013 Jun 10.

Individual and center-level factors affecting mortality among extremely low birth weight infants

Brandon W Alleman  1 , Edward F Bell, Lei Li, John M Dagle, P Brian Smith, Namasivayam Ambalavanan, Matthew M Laughon, Barbara J Stoll, Ronald N Goldberg, Waldemar A Carlo, Jeffrey C Murray, C Michael Cotten, Seetha Shankaran, Michele C Walsh, Abbot R Laptook, Dan L Ellsbury, Ellen C Hale, Nancy S Newman, Dennis D Wallace, Abhik Das, Rosemary D Higgins; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Comparative Study

Individual and center-level factors affecting mortality among extremely low birth weight infants

Brandon W Alleman et al. Pediatrics. 2013 Jul.

Abstract

Objective: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants.

Methods: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006-2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs <25 weeks and ≥25 weeks.

Results: Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs <25 weeks, and 1% to 11% and 7% to 26% for GAs ≥25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants <25 weeks. For infants ≥25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates.

Conclusions: Center intervention rates explain a portion of the center variation in mortality, especially for infants born at <25 weeks' GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA ≥25 weeks these differences account for only a small part of the variation in mortality.

Keywords: NICU; extremely preterm infants; mortality rates; outcome; preterm infants.

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Figures

FIGURE 1
FIGURE 1
Mortality rates by center. A, Results for infants of all GAs (22 [0/7] through 28 [6/7] weeks). B, Results for infants with GA of 22 [0/7] through 24 [6/7] weeks. C, Results for infants with GA of 25 [0/7] through 28 [6/7] weeks. Closed circles represent in-hospital mortality and open circles early (≤12 hours) mortality. The size of the circles represents the number of infants treated at a given center over the study period. The centers are ordered by in-hospital mortality for each graph individually, which means that a center may not have the same number in each panel.
See this image and copyright information in PMC

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