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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Alleman, BW; Bell, EF; Li, L; Dagle, JM; Smith, PB; Ambalavanan, N; Laughon, MM; Stoll, BJ; Goldberg, RN; Carlo, WA; Murray, JC; Cotten, CM; Shankaran, S; Walsh, MC; Laptook, AR; Ellsbury, DL; Hale, EC; Newman, NS; Wallace, DD; Das, A; Higgins, RD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network,

Published Date

  • July 2013

Published In

Volume / Issue

  • 132 / 1

Start / End Page

  • e175 - e184

PubMed ID

  • 23753096

Pubmed Central ID

  • PMC3691533

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

Digital Object Identifier (DOI)

  • 10.1542/peds.2012-3707


  • eng

Conference Location

  • United States