Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2206-2214 (doi:10.1542/peds.2005-1624)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (4)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bartels, D. B.
Right arrow Articles by Poets, C. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bartels, D. B.
Right arrow Articles by Poets, C. F.
Related Collections
Right arrow Premature & Newborn

Hospital Volume and Neonatal Mortality Among Very Low Birth Weight Infants

Dorothee B. Bartels, PhD, MSca,c, David Wypij, PhDb, Paul Wenzlaffc, Olaf Dammann, MDd,e and Christian F. Poets, MDf

a Departments of Obstetrics, Pulmonology and Neonatology, and Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
b Children’s Hospital and Harvard School of Public Health, Boston, Massachusetts
c Center for Quality Assurance and Management in Health Care, Hannover, Germany
d Departments of Obstetrics and Pediatrics, Perinatal Infectious Disease Epidemiology Unit, Hannover Medical School, Hannover, Germany
e Neuroepidemiology Unit, Departments of Neurology, Children’s Hospital and Harvard Medical School, Boston, Massachusetts
f Department of Neonatology, University of Tübingen, Tübingen, Germany

BACKGROUND. Very low birth weight infants (<1500 g) are at increased mortality risk. Data on the impact of NICU volume are sparse, in comparison with those on the level of care. We hypothesized that neonatal mortality would be higher in small NICUs (<36 very low birth weight admissions per year) than in large NICUs, with adjustment for volume of the delivery unit.

METHODS. We analyzed population-based data from a quality assurance program in Lower Saxony (Germany). Perinatal data for almost all very low birth weight infants born in 1991 to 1999 (n = 7745) were available. Analyses were restricted to infants born at 24 to 30 weeks (n = 4379). Data validation procedures, univariate data analyses, and logistic regression models based on general estimating equations were performed.

RESULTS. Neonatal mortality among infants admitted to NICUs was 12.2% in small NICUs and 10.2% in large NICUs. The mortality rate in small NICUs was increased significantly. Compared with infants from large delivery hospitals (>1000 births per year) and large NICUs, the adjusted odds ratio was 1.94 for neonates for whom both units were small, 1.75 for those from large delivery units but small neonatal units, and 1.16 for those for whom only the NICU was large. Stratification according to gestational age revealed the greatest impact on mortality for infants of <29 weeks.

CONCLUSIONS. Results suggest that creating larger perinatal centers may improve perinatal health care. The volume of the NICU was associated more strongly with 28-day mortality than was the volume of the delivery hospital, and it had the largest impact on survival for infants of <29 weeks.

Key Words: very low birth weight infant • neonatal mortality • hospital volume • regionalization

Abbreviations: VLBW—very low birth weight • SGA—small for gestational age • OR—odds ratio • CI—confidence interval

Accepted Dec 21, 2005.




This article has been cited by other articles:


Home page
 NEJMHome page
E. C. Eichenwald and A. R. Stark
Management and Outcomes of Very Low Birth Weight
N. Engl. J. Med., April 17, 2008; 358(16): 1700 - 1711.
[Full Text] [PDF]