The impact of volume and neonatal level of care on outcomes of moderate and late preterm infants.

Autor: Salazar EG; Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. salazare@chop.edu.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. salazare@chop.edu.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. salazare@chop.edu., Passarella M; Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Formanowski B; Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Phibbs CS; Stanford University School of Medicine, Stanford, CA, USA.; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA., Lorch SA; Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Handley SC; Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Journal of perinatology : official journal of the California Perinatal Association [J Perinatol] 2024 Oct; Vol. 44 (10), pp. 1409-1415. Date of Electronic Publication: 2024 Feb 27.
DOI: 10.1038/s41372-024-01901-x
Abstrakt: Objective: Evaluate the relationship of neonatal unit level of care (LOC) and volume with mortality or morbidity in moderate-late preterm (MLP) (32-36 weeks' gestation) infants.
Design: Retrospective cohort study of 650,865 inborn MLP infants in 4976 hospitals-years using 2003-2015 linked administrative data from 4 states. Exposure was combined neonatal LOC and MLP annual volume. The primary outcome was death or morbidity (respiratory distress syndrome, severe intraventricular hemorrhage, necrotizing enterocolitis, sepsis, infection, pneumothorax, extreme length of stay) with components as secondary outcomes. Poisson regression models adjusted for patient characteristics with a random effect for unit were used.
Results: In adjusted models, high-volume level 2 units had a lower risk of the primary outcome compared to low-volume level 3 units (aIRR 0.90 [95% CI 0.83-0.98] vs. aIRR 1.13 [95% CI 1.03-1.24], p < 0.001) CONCLUSION: MLP infants had improved outcomes in high-volume level 2 units compared to low-volume level 3 units in adjusted analysis.
(© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)
Databáze: MEDLINE
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