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The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study.
BMJ Open. 2014 Jul 07; 4(7):e004856.BO

Abstract

OBJECTIVE

To examine the effects of designation and volume of neonatal care at the hospital of birth on mortality and morbidity outcomes in very preterm infants in a managed clinical network setting.

DESIGN

A retrospective, population-based analysis of operational clinical data using adjusted logistic regression and instrumental variables (IV) analyses.

SETTING

165 National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing and Clinical Outcomes Project.

PARTICIPANTS

20 554 infants born at <33 weeks completed gestation (17 995 born at 27-32 weeks; 2559 born at <27 weeks), admitted to neonatal care and either discharged or died, over the period 1 January 2009-31 December 2011.

INTERVENTION

Tertiary designation or high-volume neonatal care at the hospital of birth.

OUTCOMES

Neonatal mortality, any in-hospital mortality, surgery for necrotising enterocolitis, surgery for retinopathy of prematurity, bronchopulmonary dysplasia and postmenstrual age at discharge.

RESULTS

Infants born at <33 weeks gestation and admitted to a high-volume neonatal unit at the hospital of birth were at reduced odds of neonatal mortality (IV regression odds ratio (OR) 0.70, 95% CI 0.53 to 0.92) and any in-hospital mortality (IV regression OR 0.68, 95% CI 0.54 to 0.85). The effect of volume on any in-hospital mortality was most acute among infants born at <27 weeks gestation (IV regression OR 0.51, 95% CI 0.33 to 0.79). A negative association between tertiary-level unit designation and mortality was also observed with adjusted logistic regression for infants born at <27 weeks gestation.

CONCLUSIONS

High-volume neonatal care provided at the hospital of birth may protect against in-hospital mortality in very preterm infants. Future developments of neonatal services should promote delivery of very preterm infants at hospitals with high-volume neonatal units.

Authors+Show Affiliations

Warwick Medical School, University of Warwick, Coventry, UK.Department of Economics, University of Warwick, Coventry, UK.Warwick Medical School, University of Warwick, Coventry, UK.Academic Neonatology, UCL Institute for Women's Health, London, UK.Academic Neonatology, UCL Institute for Women's Health, London, UK.Department of Health Sciences, University of Leicester, Leicester, UK.Section of Neonatal Medicine, Department of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK.Section of Neonatal Medicine, Department of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25001393

Citation

Watson, S I., et al. "The Effects of Designation and Volume of Neonatal Care On Mortality and Morbidity Outcomes of Very Preterm Infants in England: Retrospective Population-based Cohort Study." BMJ Open, vol. 4, no. 7, 2014, pp. e004856.
Watson SI, Arulampalam W, Petrou S, et al. The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. BMJ Open. 2014;4(7):e004856.
Watson, S. I., Arulampalam, W., Petrou, S., Marlow, N., Morgan, A. S., Draper, E. S., Santhakumaran, S., & Modi, N. (2014). The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. BMJ Open, 4(7), e004856. https://doi.org/10.1136/bmjopen-2014-004856
Watson SI, et al. The Effects of Designation and Volume of Neonatal Care On Mortality and Morbidity Outcomes of Very Preterm Infants in England: Retrospective Population-based Cohort Study. BMJ Open. 2014 Jul 7;4(7):e004856. PubMed PMID: 25001393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. AU - Watson,S I, AU - Arulampalam,W, AU - Petrou,S, AU - Marlow,N, AU - Morgan,A S, AU - Draper,E S, AU - Santhakumaran,S, AU - Modi,N, AU - ,, Y1 - 2014/07/07/ PY - 2014/7/9/entrez PY - 2014/7/9/pubmed PY - 2014/7/9/medline SP - e004856 EP - e004856 JF - BMJ open JO - BMJ Open VL - 4 IS - 7 N2 - OBJECTIVE: To examine the effects of designation and volume of neonatal care at the hospital of birth on mortality and morbidity outcomes in very preterm infants in a managed clinical network setting. DESIGN: A retrospective, population-based analysis of operational clinical data using adjusted logistic regression and instrumental variables (IV) analyses. SETTING: 165 National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing and Clinical Outcomes Project. PARTICIPANTS: 20 554 infants born at <33 weeks completed gestation (17 995 born at 27-32 weeks; 2559 born at <27 weeks), admitted to neonatal care and either discharged or died, over the period 1 January 2009-31 December 2011. INTERVENTION: Tertiary designation or high-volume neonatal care at the hospital of birth. OUTCOMES: Neonatal mortality, any in-hospital mortality, surgery for necrotising enterocolitis, surgery for retinopathy of prematurity, bronchopulmonary dysplasia and postmenstrual age at discharge. RESULTS: Infants born at <33 weeks gestation and admitted to a high-volume neonatal unit at the hospital of birth were at reduced odds of neonatal mortality (IV regression odds ratio (OR) 0.70, 95% CI 0.53 to 0.92) and any in-hospital mortality (IV regression OR 0.68, 95% CI 0.54 to 0.85). The effect of volume on any in-hospital mortality was most acute among infants born at <27 weeks gestation (IV regression OR 0.51, 95% CI 0.33 to 0.79). A negative association between tertiary-level unit designation and mortality was also observed with adjusted logistic regression for infants born at <27 weeks gestation. CONCLUSIONS: High-volume neonatal care provided at the hospital of birth may protect against in-hospital mortality in very preterm infants. Future developments of neonatal services should promote delivery of very preterm infants at hospitals with high-volume neonatal units. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/25001393/The_effects_of_designation_and_volume_of_neonatal_care_on_mortality_and_morbidity_outcomes_of_very_preterm_infants_in_England:_retrospective_population_based_cohort_study_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=25001393 DB - PRIME DP - Unbound Medicine ER -