Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants

Ciaran S. Phibbs, Laurence C. Baker, Aaron Caughey, Beate Danielsen, Susan K. Schmitt, Roderic H. Phibbs

Research output: Contribution to journalArticle

303 Citations (Scopus)

Abstract

BACKGROUND: There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units. We examined differences in neonatal mortality among infants with very low birth weight (below 1500 g) among NICUs with various levels of care and different volumes of very-low-birth-weight infants. METHODS: We linked birth certificates, hospital discharge abstracts (including interhospital transfers), and fetal and infant death certificates to assess neonatal mortality rates among 48,237 very-low-birth-weight infants who were born in California hospitals between 1991 and 2000. RESULTS: Mortality rates among very-low-birth-weight infants varied according to both the volume of patients and the level of care at the delivery hospital. The effect of volume also varied according to the level of care. As compared with a high level of care and a high volume of very-low-birth-weight infants (more than 100 per year), lower levels of care and lower volumes (except for those of two small groups of hospitals) were associated with significantly higher odds ratios for death, ranging from 1.19 (95% confidence interval [CI], 1.04 to 1.37) to 2.72 (95% CI, 2.37 to 3.12). Less than one quarter of very-low-birth-weight deliveries occurred in facilities with NICUs that offered a high level of care and had a high volume, but 92% of very-low-birth-weight deliveries occurred in urban areas with more than 100 such deliveries. CONCLUSIONS: Mortality among very-low-birth-weight infants was lowest for deliveries that occurred in hospitals with NICUs that had both a high level of care and a high volume of such patients. Our results suggest that increased use of such facilities might reduce mortality among very-low-birth-weight infants.

Original languageEnglish (US)
Pages (from-to)2165-2175
Number of pages11
JournalNew England Journal of Medicine
Volume356
Issue number21
DOIs
StatePublished - May 24 2007
Externally publishedYes

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Neonatal Intensive Care
Very Low Birth Weight Infant
Mortality
Neonatal Intensive Care Units
Infant Mortality
Confidence Intervals
Birth Certificates
Death Certificates
Fetal Death
Community Hospital
Patient Care
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

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Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. / Phibbs, Ciaran S.; Baker, Laurence C.; Caughey, Aaron; Danielsen, Beate; Schmitt, Susan K.; Phibbs, Roderic H.

In: New England Journal of Medicine, Vol. 356, No. 21, 24.05.2007, p. 2165-2175.

Research output: Contribution to journalArticle

Phibbs, Ciaran S. ; Baker, Laurence C. ; Caughey, Aaron ; Danielsen, Beate ; Schmitt, Susan K. ; Phibbs, Roderic H. / Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. In: New England Journal of Medicine. 2007 ; Vol. 356, No. 21. pp. 2165-2175.
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AU - Baker, Laurence C.

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AU - Danielsen, Beate

AU - Schmitt, Susan K.

AU - Phibbs, Roderic H.

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N2 - BACKGROUND: There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units. We examined differences in neonatal mortality among infants with very low birth weight (below 1500 g) among NICUs with various levels of care and different volumes of very-low-birth-weight infants. METHODS: We linked birth certificates, hospital discharge abstracts (including interhospital transfers), and fetal and infant death certificates to assess neonatal mortality rates among 48,237 very-low-birth-weight infants who were born in California hospitals between 1991 and 2000. RESULTS: Mortality rates among very-low-birth-weight infants varied according to both the volume of patients and the level of care at the delivery hospital. The effect of volume also varied according to the level of care. As compared with a high level of care and a high volume of very-low-birth-weight infants (more than 100 per year), lower levels of care and lower volumes (except for those of two small groups of hospitals) were associated with significantly higher odds ratios for death, ranging from 1.19 (95% confidence interval [CI], 1.04 to 1.37) to 2.72 (95% CI, 2.37 to 3.12). Less than one quarter of very-low-birth-weight deliveries occurred in facilities with NICUs that offered a high level of care and had a high volume, but 92% of very-low-birth-weight deliveries occurred in urban areas with more than 100 such deliveries. CONCLUSIONS: Mortality among very-low-birth-weight infants was lowest for deliveries that occurred in hospitals with NICUs that had both a high level of care and a high volume of such patients. Our results suggest that increased use of such facilities might reduce mortality among very-low-birth-weight infants.

AB - BACKGROUND: There has been a large increase in both the number of neonatal intensive care units (NICUs) in community hospitals and the complexity of the cases treated in these units. We examined differences in neonatal mortality among infants with very low birth weight (below 1500 g) among NICUs with various levels of care and different volumes of very-low-birth-weight infants. METHODS: We linked birth certificates, hospital discharge abstracts (including interhospital transfers), and fetal and infant death certificates to assess neonatal mortality rates among 48,237 very-low-birth-weight infants who were born in California hospitals between 1991 and 2000. RESULTS: Mortality rates among very-low-birth-weight infants varied according to both the volume of patients and the level of care at the delivery hospital. The effect of volume also varied according to the level of care. As compared with a high level of care and a high volume of very-low-birth-weight infants (more than 100 per year), lower levels of care and lower volumes (except for those of two small groups of hospitals) were associated with significantly higher odds ratios for death, ranging from 1.19 (95% confidence interval [CI], 1.04 to 1.37) to 2.72 (95% CI, 2.37 to 3.12). Less than one quarter of very-low-birth-weight deliveries occurred in facilities with NICUs that offered a high level of care and had a high volume, but 92% of very-low-birth-weight deliveries occurred in urban areas with more than 100 such deliveries. CONCLUSIONS: Mortality among very-low-birth-weight infants was lowest for deliveries that occurred in hospitals with NICUs that had both a high level of care and a high volume of such patients. Our results suggest that increased use of such facilities might reduce mortality among very-low-birth-weight infants.

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