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Association of center-specific patient volumes and early respiratory management practices with death and bronchopulmonary dysplasia in preterm infants

Citation

Spotswood, N and Orsini, F and Dargaville, P, for the Australian and New Zealand Neonatal Network, Association of center-specific patient volumes and early respiratory management practices with death and bronchopulmonary dysplasia in preterm infants, The Journal of Pediatrics, 210 pp. 63-68. ISSN 0022-3476 (2019) [Refereed Article]


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Copyright Statement

Copyright 2019 Elsevier Inc.

DOI: doi:10.1016/j.jpeds.2019.02.036

Abstract

Objectives: To describe variability in admission volumes and approach to early respiratory support between neonatal intensive care units in the Australian and New Zealand Neonatal Network and to evaluate whether these center-specific factors are associated with death and bronchopulmonary dysplasia.

Study Design: This retrospective cohort study included 19 099 neonates born between 25 and 32 weeks' gestation and admitted to 1 of 25 NICUs from 2007 to 2013. Center-specific factors evaluated were annual admission volume and rate of using continuous positive airway pressure (CPAP) rather than intubation as the first mode of respiratory support. Logistic regression was used to examine any association of these center-specific factors with death, BPD, and death or survival with BPD (death/BPD). Analysis was performed separately for 2 gestation groups (25-28 weeks and 29-32 weeks inclusive).

Results: Admission volumes and rates of early CPAP use varied widely across centers. Higher admission volumes were associated with lower odds of death or survival with BPD in the 25-28 week group (aOR 0.93, 99% CI 0.88-0.99 per increase of 10 babies per center annually). Centers with higher early CPAP use did not have lower odds of death or BPD than centers that intubated more frequently.

Conclusions: Higher admission volumes are associated with more favorable outcomes for the more preterm infants in the Australian and New Zealand Neonatal Network. Further investigation is required to explore why the individual benefits of early CPAP do not translate to better outcomes for centers that use this approach most frequently.

Item Details

Item Type:Refereed Article
Keywords:health services research, hospital mortality
Research Division:Medical and Health Sciences
Research Group:Paediatrics and Reproductive Medicine
Research Field:Paediatrics
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Child Health
UTAS Author:Dargaville, P (Professor Peter Dargaville)
ID Code:133065
Year Published:2019
Web of Science® Times Cited:2
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-06-05
Last Modified:2020-03-11
Downloads:0

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