Impact of Hospital Birth Volume on Neonate Outcomes After Hypothermia
Author Information
Author(s): Craig Alexa, Cutler Anya, Kerecman Jay, Melendi Misty, Seften Leah Marie, Ryzewski Matthew, Zanno Allison, Barkhuff Whittney, O’Reilly Deirdre
Primary Institution: Barbara Bush Children’s Hospital at Maine Medical Center
Hypothesis
Outborn neonates from smaller birth volume hospitals would have more frequent adverse short-term outcomes following therapeutic hypothermia.
Conclusion
Neonates born in small volume hospitals had significantly higher odds of death or severe gray matter injury following therapeutic hypothermia.
Supporting Evidence
- 531 neonates were included from small, medium, and large volume hospitals.
- The odds of the combined outcome were 4.3-fold higher in small versus large birth volume hospitals.
- TH was initiated at a median of 4.5 hours for small hospitals compared to 2 hours for large hospitals.
- Mortality prior to hospital discharge was highest among neonates born at small birth volume hospitals.
Takeaway
Babies born in smaller hospitals are more likely to have serious health problems after treatment than those born in larger hospitals.
Methodology
Multicenter retrospective study comparing outcomes for small, medium, and large hospitals using multivariable logistic regression.
Potential Biases
Potential residual confounding from sociodemographic variable differences.
Limitations
Lack of comprehensive data on longer-term neurodevelopmental outcomes and missing data on outborn neonates.
Participant Demographics
Mothers in small and medium hospitals were younger and had fewer medical comorbidities.
Statistical Information
P-Value
0.004
Confidence Interval
95% CI = 1.6, 12.1
Statistical Significance
p=0.004
Digital Object Identifier (DOI)
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