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

Publication ,  Journal Article
Alleman, BW; Bell, EF; Li, L; Dagle, JM; Smith, PB; Ambalavanan, N; Laughon, MM; Stoll, BJ; Goldberg, RN; Carlo, WA; Murray, JC; Cotten, CM ...
Published in: Pediatrics
July 2013

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.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

July 2013

Volume

132

Issue

1

Start / End Page

e175 / e184

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Registries
  • Practice Patterns, Physicians'
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Premature, Diseases
  • Infant, Newborn
  • Infant, Extremely Low Birth Weight
 

Citation

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Alleman, B. W., Bell, E. F., Li, L., Dagle, J. M., Smith, P. B., Ambalavanan, N., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, . (2013). Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics, 132(1), e175–e184. https://doi.org/10.1542/peds.2012-3707
Alleman, Brandon W., Edward F. Bell, Lei Li, John M. Dagle, P Brian Smith, Namasivayam Ambalavanan, Matthew M. Laughon, et al. “Individual and center-level factors affecting mortality among extremely low birth weight infants.Pediatrics 132, no. 1 (July 2013): e175–84. https://doi.org/10.1542/peds.2012-3707.
Alleman BW, Bell EF, Li L, Dagle JM, Smith PB, Ambalavanan N, et al. Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics. 2013 Jul;132(1):e175–84.
Alleman, Brandon W., et al. “Individual and center-level factors affecting mortality among extremely low birth weight infants.Pediatrics, vol. 132, no. 1, July 2013, pp. e175–84. Pubmed, doi:10.1542/peds.2012-3707.
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. Individual and center-level factors affecting mortality among extremely low birth weight infants. Pediatrics. 2013 Jul;132(1):e175–e184.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

July 2013

Volume

132

Issue

1

Start / End Page

e175 / e184

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Registries
  • Practice Patterns, Physicians'
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Premature, Diseases
  • Infant, Newborn
  • Infant, Extremely Low Birth Weight