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Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.

Abstract：

IMPORTANCE:There has been a significant expansion in the number of low-level and midlevel neonatal intensive care units (NICUs) in recent decades. Infants with necrotizing enterocolitis represent a high-risk subgroup of the very low-birth-weight (VLBW) (<1500 g) population that would benefit from focused regionalization. OBJECTIVES:To describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. DESIGN, SETTING, AND PARTICIPANTS:A retrospective cohort study was conducted of NICUs in California. We used data collected by the California Perinatal Quality Care Collaborative from 2005 to 2011 to assess mortality rates among a population-based sample of 30 566 VLBW infants, 1879 with necrotizing enterocolitis, according to the level of care and VLBW case volume at the hospital of birth. EXPOSURES:Level and volume of neonatal intensive care at the hospital of birth. MAIN OUTCOMES AND MEASURES:In-hospital mortality. RESULTS:There was a persistent trend toward deregionalization during the study period and mortality rates varied according to the level of care. High-level, high-volume (level IIIB with >100 VLBW cases per year and level IIIC) hospitals achieved the lowest risk-adjusted mortality. Infants with necrotizing enterocolitis born into midlevel hospitals (low-volume level IIIB and level IIIA NICUs) had odds of death ranging from 1.42 (95% CI, 1.08-1.87) to 1.51 (95% CI, 1.05-2.15, respectively). In the final year of the study, just 28.6% of the infants with necrotizing enterocolitis were born into high-level, high-volume hospitals. For infants born into lower level centers, transfer to a higher level of care frequently occurred well into the third week of life. CONCLUSIONS AND RELEVANCE:These findings represent an immediate opportunity for local quality improvement initiatives and potential impetus for the regionalization of important NICU resources.

journal_name

JAMA Pediatr

journal_title

JAMA pediatrics

authors

Kastenberg ZJ,Lee HC,Profit J,Gould JB,Sylvester KG

doi

10.1001/jamapediatrics.2014.2085

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

26-32

issue

eissn

2168-6203

issn

2168-6211

pii

1921651

journal_volume

169

pub_type

杂志文章

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Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.