The Impact of Hospital Delivery Volumes of Newborns Born Very Preterm on Mortality and Morbidity

IF 3.9 2区 医学 Q1 PEDIATRICS
Ciaran S. Phibbs PhD , Molly Passarella MS , Susan K. Schmitt RN, PhD , Ashley Martin MPH , Scott A. Lorch MD, MSCE
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Abstract

Objective

To examine if the annual patient volume of infants born very preterm (VPT, gestational age <32 weeks) at a hospital is associated with neonatal mortality and morbidity.

Study design

We performed an observational, secondary data analysis using a 20-year panel of birth certificates linked to hospital discharge abstracts, including transfers in California, Michigan, Missouri, Oregon, Pennsylvania, and South Carolina from 1996 through 2015. The study included all in-hospital VPT deliveries (n = 208 261). Study outcomes were in-hospital mortality or serious morbidity (intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, or bronchopulmonary dysplasia), attributed to the hospital of birth. Poisson regression models estimated the risk-adjusted relative risk (RR) for mortality and serious morbidity across different patient volume categories within a given hospital using hospital fixed effects.

Results

The risk of mortality and serious morbidity for VPT infants increased as the number of infants born VPT at a hospital decreased. Compared with VPT delivery volumes >100 infants per year, the risk of mortality increased when a given hospital had VPT delivery volumes < 60 per year, ranging from a RR of 1.13 (95% C.I. 1.02-1.25) for volumes between 50 to 59 and 1.39 (1.19-1.62) for VPT volumes <10, and the risk of mortality or serious morbidity increased when a given hospital had VPT volumes <100, ranging from a RR of 1.05 (1.02-1.08) for volumes between 90 to 99 and 1.27 (1.19-1.36) for VPT volumes <10.

Conclusions

These results suggest that, for VPT infants, the risk of both mortality and mortality or serious morbidity is increased as the VPT volume within a given hospital declines.
极早产儿的住院分娩量对死亡率和发病率的影响。
研究目的研究设计:我们使用与医院出院摘要关联的出生证明面板进行了为期 20 年的观察性二次数据分析,其中包括 1996 年至 2015 年期间在加利福尼亚州、密歇根州、密苏里州、俄勒冈州、宾夕法尼亚州和南卡罗来纳州的转院情况。该研究包括所有院内 VPT 分娩(N=208,261)。研究结果为出生医院导致的院内死亡率或严重发病率(脑室内出血、坏死性小肠结肠炎、早产儿视网膜病变或支气管肺发育不良)。泊松回归模型利用医院固定效应估算了特定医院内不同患者数量类别的死亡率和严重发病率的风险调整相对风险(RR):结果:VPT 婴儿的死亡和严重发病风险随着医院 VPT 婴儿出生人数的减少而增加。与每年 VPT 分娩量大于 100 名婴儿相比,当某医院每年 VPT 分娩量小于 60 名婴儿时,死亡风险增加,从 50 至 59 名婴儿的 RR 值 1.13(95% C.I.1.02-1.25)到 VPT 分娩量的 RR 值 1.39(1.19-1.62)不等:这些结果表明,对于 VPT 婴儿来说,随着特定医院内 VPT 容量的减少,死亡和死亡或严重发病的风险都会增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pediatrics
Journal of Pediatrics 医学-小儿科
CiteScore
6.00
自引率
2.00%
发文量
696
审稿时长
31 days
期刊介绍: The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.
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