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N Engl J Med. 2015 May 7;372(19):1801-11. doi: 10.1056/NEJMoa1410689.

Between-hospital variation in treatment and outcomes in extremely preterm infants.

Author information

1
From the Stead Family Department of Pediatrics (M.A.R., E.F.B., J.C.M., T.T.C., J.E.B.) and the Department of Epidemiology (M.A.R.), University of Iowa, Iowa City; the Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, NC (L.L.), and Rockville, MD (A.D.); Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA (S.R.H.); Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.J.S.); Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); Department of Pediatrics, University of Alabama at Birmingham, Birmingham (W.A.C.); Department of Pediatrics, Wayne State University, Detroit (S.S.); Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland (M.C.W.); Department of Pediatrics, University of Texas Medical School at Houston, Houston (J.E.T.); Department of Pediatrics, Duke University, Durham, NC (C.M.C., P.B.S.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.).

Abstract

BACKGROUND:

Between-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth.

METHODS:

We studied infants born between April 2006 and March 2011 at 24 hospitals included in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Data were collected for 4987 infants born before 27 weeks of gestation without congenital anomalies. Active treatment was defined as any potentially lifesaving intervention administered after birth. Survival and neurodevelopmental impairment at 18 to 22 months of corrected age were assessed in 4704 children (94.3%).

RESULTS:

Overall rates of active treatment ranged from 22.1% (interquartile range [IQR], 7.7 to 100) among infants born at 22 weeks of gestation to 99.8% (IQR, 100 to 100) among those born at 26 weeks of gestation. Overall rates of survival and survival without severe impairment ranged from 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks of gestation to 81.4% (IQR, 78.2 to 84.0) and 75.6% (IQR, 69.5 to 80.0), respectively, among those born at 26 weeks of gestation. Hospital rates of active treatment accounted for 78% and 75% of the between-hospital variation in survival and survival without severe impairment, respectively, among children born at 22 or 23 weeks of gestation, and accounted for 22% and 16%, respectively, among those born at 24 weeks of gestation, but the rates did not account for any of the variation in outcomes among those born at 25 or 26 weeks of gestation.

CONCLUSIONS:

Differences in hospital practices regarding the initiation of active treatment in infants born at 22, 23, or 24 weeks of gestation explain some of the between-hospital variation in survival and survival without impairment among such patients. (Funded by the National Institutes of Health.).

PMID:
25946279
PMCID:
PMC4465092
DOI:
10.1056/NEJMoa1410689
[Indexed for MEDLINE]
Free PMC Article

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