Abstract
Background: Very low birthweight infants (VLBW, <1500g) are at increased mortality risk. Neonatal intensive care (NICU) and delivery units are often detached. Previous mortality risk assessments focused on neonatal transfers as a potentially harmful exposure. Data on the impact of NICU volume are sparse.
Objective: To assess the impact of annual VLBW-infant census on 28-day-survival. We hypothesized that neonatal mortality is higher in small NICUs (<36 VLBW admission/year) than in large NICUs, and that NICU volume has a larger impact than volume of the delivery unit (<= vs. >1000 births/year).
Methods: We analyzed population-based data from a quality assurance program in Lower Saxony (Germany). Pre-, peri- and neonatal data from almost all VLBW-infants born 1991–99 (n=7737) were available. Analyses were restricted to infants born at 24–30 wk (n=4379). Data validation procedures, univariable data analyses, logistic regression, and general estimating equation models were performed, the latter to appreciate data clustering within NICUs.
Results: Neonatal mortality among infants admitted to NICU was 12.2% in small and 10.2% in large NICUs. Infants from small NICUs had a significantly increased mortality rate (adjusted odds ratio 1.79, 95% CI 1.21–2.63). Compared to infants from large delivery units and large NICUs, the adjusted OR was 1.94 (1.20–3.14) for newborns from both units being small, 1.75 (1.10–2.78) for those from large delivery but small neonatal units, and 1.16 (0.82–1.63), if the NICU was large, but not the delivery unit. Stratification by gestational age revealed the greatest impact on mortality for infants <29 wk.
Conclusion: Our results suggest that creating larger perinatal centers might further improve perinatal health care. Volume of the NICU was more strongly associated with 28-day-mortality than that of the delivery unit, and had the largest impact on survival for infants <29 wk.
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Bartels, D., Wypij, D., Wenzlaff, P. et al. 24 Hospital Volume and Mortality in Preterm Newborns. Pediatr Res 58, 358 (2005). https://doi.org/10.1203/00006450-200508000-00053
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DOI: https://doi.org/10.1203/00006450-200508000-00053
