Very Low Birth Weight Outcomes

Abstract

To the Editor.—

In their valuable report¹ Dr Hack and colleagues confirm large variations between centers in the perinatal histories, treatment, and outcomes of very low birth weight infants. Unfortunately, in contrast to earlier reports,^2,3 they neglect to mention the need for measures of initial disease severity.

This is an important omission. In a survey of nine pediatric intensive care centers Pollack et al⁴ showed that hospital mortality varied from 3.6% to 17%. This large variation was explained completely by differences between hospital populations in initial severity of disease, calculated from routine indices of physiologic stability on the day of admission.