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Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants
Open accessAbstract
BACKGROUND: Between-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth. METHODS: We studied infants born between April 2006 and March 2011 at 24 hospitals included in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Data were collected for 4987 infants born before 27 weeks of gestation without congenital anomalies. Active treatment was defined as any potentially lifesaving intervention administered after birth. Survival and neurodevelopmental impairment at 18 to 22 months of corrected age were assessed in 4704 children (94.3%). RESULTS: Overall rates of active treatment ranged from 22.1% (interquartile range [IQR], 7.7 to 100) among infants born at 22 weeks of gestation to 99.8% (IQR, 100 to 100) among those born at 26 weeks of gestation. Overall rates of survival and survival without severe impairment ranged from 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks of gestation to 81.4% (IQR, 78.2 to 84.0) and 75.6% (IQR, 69.5 to 80.0), respectively, among those born at 26 weeks of gestation. Hospital rates of active treatment accounted for 78% and 75% of the between-hospital variation in survival and survival without severe impairment, respectively, among children born at 22 or 23 weeks of gestation, and accounted for 22% and 16%, respectively, among those born at 24 weeks of gestation, but the rates did not account for any of the variation in outcomes among those born at 25 or 26 weeks of gestation. CONCLUSIONS: Differences in hospital practices regarding the initiation of active treatment in infants born at 22, 23, or 24 weeks of gestation explain some of the between-hospital variation in survival and survival without impairment among such patients. (Funded by the National Institutes of Health.).
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Cites
One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden
(2009) · JAMA · doi:10.1001/jama.2009.771 · Cited by 662
Vohr, B. R., Wright, L. L., Poole, W. K., McDonald, S. A., & for the NICHD Neonatal Research Network Follow-up Study (2005) · Pediatrics · doi:10.1542/peds.2004-2247 · Cited by 388
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Cited by
Qiao, J., Wang, Y., Li, X., Jiang, F., Zhang, Y., Ma, J., Song, Y., Ma, J., Fu, W., Pang, R., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32708-2 · Cited by 569
Survival and Neurodevelopmental Outcomes among Periviable Infants
Younge, N., Goldstein, R. F., Bann, C. M., Hintz, S. R., Patel, R. M., Smith, P. B., Bell, E. F., Rysavy, M. A., Duncan, A. F., Vohr, B. R., et al. (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1605566 · Cited by 538
Self-citationPierrat, V., Marchand-Martin, L., Arnaud, C., Kaminski, M., Resche-Rigon, M., Lebeaux, C., Bodeau-Livinec, F., Morgan, A. S., Goffinet, F., Marret, S., et al. (2017) · BMJ · doi:10.1136/bmj.j3448 · Cited by 482
Obstetric Care Consensus No. 6: Periviable Birth
(2017) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002352 · Cited by 253
Neurodevelopmental, Mental Health, and Parenting Issues in Preterm Infants
Shaw, R. J., Givrad, S., Poe, C., Loi, E. C., Hoge, M. K., & Scala, M. (2023) · Children · doi:10.3390/children10091565 · Cited by 54
Metadata
- Authors
- Rysavy, M. A., Li, L., Bell, E. F., Das, A., Hintz, S. R., Stoll, B. J., Vohr, B. R., Carlo, W. A., Shankaran, S., Walsh, M. C., Tyson, J. E., Cotten, C. M., Smith, P. B., Murray, J. C., Colaizy, T. T., Brumbaugh, J. E., & Higgins, R. D.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-05-07
- Volume
- 372
- Issue
- 19
- Pages
- 1801-1811
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1553438539
- Cited by
- 668
- References
- 2
- FWCI
- 64.82
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Rysavy, M. A., Li, L., Bell, E. F., Das, A., Hintz, S. R., Stoll, B. J., Vohr, B. R., Carlo, W. A., Shankaran, S., Walsh, M. C., Tyson, J. E., Cotten, C. M., Smith, P. B., Murray, J. C., Colaizy, T. T., Brumbaugh, J. E., & Higgins, R. D. (2015). Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1410689
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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