PEDIATRICS Vol. 82 No. 4 October 1988, pp. 554-559
This Article
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 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 Google Scholar
Google Scholar
Right arrow Articles by Horbar, J. D.
Right arrow Articles by Wilkinson, A. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Horbar, J. D.
Right arrow Articles by Wilkinson, A. R.

Variability in 28-Day Outcomes for Very Low Birth Weight Infants: An Analysis of 11 Neonatal Intensive Care Units

Jeffrey D. Horbar MD1, Timothy L. McAuliffe PhD1, Saul M. Adler MD1, Susan Albersheim MD1, George Cassady MD1, William Edwards MD1, Rosamond Jones MD1, John Kattwinkel MD1, Ernest N. Kraybill MD1, Venkatesan Krishnan MD1, Paula Raschko MD1, and Andrew R. Wilkinson MD1

1 From the Departments of Pediatrics and Biostatistics, University of Vermont, Burlington; Northside Hospital, Atlanta; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of Alabama, Birmingham; Dartmouth Medical School, Hanover, New Hampshire; Hammersmith Hospital, London; University of Virginia, Charlottesville; University of North Carolina, Chapel Hill; The Toledo Hospital, Toledo; Oregon Health Sciences University, Portland; and University of Oxford, Oxford, England

A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period. Of these infants, 85% (1,512) survived 28 days, a range of 80% to 92% at the individual centers. A total of 60% (1,056) of the infants were alive without supplemental oxygen on day 28, a range of 5l% to 70% at the individual centers. Multivariate analysis demonstrated that both survival on day 28 (khgr2 = 23.9, P < .01) and survival without supplemental oxygen on day 28 (khgr2 = 44.2, P < .0001) varied significantly among centers after the effects of birth weight, gender, and race were taken into account. Female gender, nonwhite race, and increased birth weight were factors associated with improved rates of survival and survival without supplemental oxygen. The magnitude of outcome variation among centers was estimated by using the logistic regression models to predict what the outcomes would be if each center were to treat a standardized population consisting of all 1,776 study infants. Predicted survival rates varied by as much as 15% and the predicted rates for survival without supplemental oxygen varied by nearly 17% between centers with the highest and lowest rates. The differences in outcomes observed at the centers did not correlate with the number of live births at the centers or with the scores on a simple respiratory practices questionnaire. It was concluded that 28-day outcomes for very low birth weight infants vary significantly among different neonatal intensive care centers. Potential sources of this variation include undetected population differences in neonatal disease severity and differences in the techniques of both obstetrical and neonatal care.

Key Words: neonate • very low birth weight • intensive care • survival • chronic lung illness

Submitted on May 26, 1987
Accepted on November 30, 1987




This article has been cited by other articles:


Home page
 PediatricsHome page
R. A. K. Jones and on behalf of the Collaborative Dexamethasone Trial
Randomized, Controlled Trial of Dexamethasone in Neonatal Chronic Lung Disease: 13- to 17-Year Follow-up Study: I. Neurologic, Psychological, and Educational Outcomes
Pediatrics, August 1, 2005; 116(2): 370 - 378.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. A. K. Jones and on behalf of the Collaborative Dexamethasone Trial
Randomized, Controlled Trial of Dexamethasone in Neonatal Chronic Lung Disease: 13- to 17-Year Follow-up Study: II. Respiratory Status, Growth, and Blood Pressure
Pediatrics, August 1, 2005; 116(2): 379 - 384.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
S. M. Touch, J. S. Greenspan, M. S. Kornhauser, and A. R. Spitzer
Intensive Care Management of the Term Neonate: Are There Regional Differences in Outcome?
Clinical Pediatrics, October 1, 2002; 41(8): 587 - 592.
[Abstract] [PDF]

Home page
 PediatricsHome page
E. C. Eichenwald, M. Blackwell, J. S. Lloyd, T. Tran, R. E. Wilker, and D. K. Richardson
Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management
Pediatrics, October 1, 2001; 108(4): 928 - 933.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. K. Richardson
A Woman With an Extremely Premature Newborn
JAMA, September 26, 2001; 286(12): 1498 - 1505.
[Full Text] [PDF]

Home page
 PediatricsHome page
H. Z. Aly
Nasal Prongs Continuous Positive Airway Pressure: A Simple Yet Powerful Tool
Pediatrics, September 1, 2001; 108(3): 759 - 761.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
E Eber and M S Zach
Paediatric origins of adult lung disease {bullet} 8: Long term sequelae of bronchopulmonary dysplasia (chronic lung disease of infancy)
Thorax, April 1, 2001; 56(4): 317 - 323.
[Full Text]

Home page
 Arch Pediatr Adolesc MedHome page
A.-M. Brooks, R. S. Byrd, M. Weitzman, P. Auinger, and J. T. McBride
Impact of Low Birth Weight on Early Childhood Asthma in the United States
Arch Pediatr Adolesc Med, March 1, 2001; 155(3): 401 - 406.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. J. Van Marter, E. N. Allred, M. Pagano, U. Sanocka, R. Parad, M. Moore, M. Susser, N. Paneth, A. Leviton, the Neonatology Committee, et al.
Do Clinical Markers of Barotrauma and Oxygen Toxicity Explain Interhospital Variation in Rates of Chronic Lung Disease?
Pediatrics, June 1, 2000; 105(6): 1194 - 1201.
[Abstract] [Full Text]

Home page
 PediatricsHome page
D. D. Marshall, M. Kotelchuck, T. E. Young, C. L. Bose, L. Kruyer, T. M. O'Shea, and the North Carolina Neonatologists Association
Risk Factors for Chronic Lung Disease in the Surfactant Era: A North Carolina Population-based Study of Very Low Birth Weight Infants
Pediatrics, December 1, 1999; 104(6): 1345 - 1350.
[Abstract] [Full Text]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. J. COALSON, V. T. WINTER, T. SILER-KHODR, and B. A. YODER
Neonatal Chronic Lung Disease in Extremely Immature Baboons
Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1333 - 1346.
[Abstract] [Full Text]

Home page
 PediatricsHome page
L. Charafeddine, C. T. D'Angio, and D. L. Phelps
Atypical Chronic Lung Disease Patterns in Neonates
Pediatrics, April 1, 1999; 103(4): 759 - 765.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
B Zernikow, K Holtmannspoetter, E Michel, W Pielemeier, F Hornschuh, A Westermann, and K H Hennecke
Artificial neural network for risk assessment in preterm neonates
Arch. Dis. Child. Fetal Neonatal Ed., September 1, 1998; 79(2): 129F - 134.
[Abstract] [Full Text]

Home page
 PediatricsHome page
M. C. McCormick
The Outcomes of Very Low Birth Weight Infants: Are We Asking the Right Questions?
Pediatrics, June 1, 1997; 99(6): 869 - 869.
[Full Text] [PDF]

Home page
 PediatricsHome page
J. D. Horbar, G. J. Badger, E. M. Lewit, J. Rogowski, and P. H. Shiono
Hospital and Patient Characteristics Associated With Variation in 28-Day Mortality Rates for Very Low Birth Weight Infants
Pediatrics, February 1, 1997; 99(2): 149 - 156.
[Abstract] [Full Text] [PDF]

Home page
 Med Decis MakingHome page
J. D. Horbar
Birthweight-adjusted Mortality Rates for Assessing the Effectiueness of Neonatal Intensive Care
Med Decis Making, December 1, 1992; 12(4): 259 - 264.
[Abstract] [PDF]