Perinatal Regionalization for Very Low-Birth-Weight and Very Preterm Infants

Lasswell, Sarah M.; Barfield, Wanda D.; Rochat, Roger W.; Blackmon, Lillian R.

doi:10.1001/jama.2010.1226

Cited by 334 publications

(295 citation statements)

References 57 publications

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“…1,4,5,6,23,24,25,26 This study's mortality rates were similar to rates found in other institutions 27 . Though this study was carried out over a short period of time with a small sample size, our results suggest a reduction in overall mortality in non-NICU-TM hospitals (Table 2).…”

Section: Discussionsupporting

confidence: 87%

“…Mortality rates range from 15% to 25% 1, 2, 3 and survival with major morbidity remains high. 1 VLBW neonates born in large perinatal centers have improved survival and adverse outcomes when compared to similar neonates born in hospitals without subspecialty care; 4,5,6,7 thus, regionalization has the potential to reduce mortality and morbidity in the VLBW neonate population. Unfortunately, despite the well-known benefits of regionalization, deregionalization of NICU care has continued to occur 7 .…”

Section: Introductionmentioning

confidence: 99%

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Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality

Kim

Teague-Ross

Greenfield

et al. 2014

Obstetrical &Amp; Gynecological Survey

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OBJECTIVES-We assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth-weight (VLBW, <1500 grams) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.STUDY DESIGN-This prospective study used obstetrical and neonatal interventions through TM consults, education, and census rounds with 9 hospitals from July 1, 2009 -March 31, 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality, and morbidity before and after TM use. Arkansas Health Department data and chi square analysis were used to compare infant mortality.RESULTS-Deliveries of VLBW neonates in targeted hospitals decreased from 13.1% to 7.0% (p=0.0099); deliveries of VLBW neonates in remaining hospitals was unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (p=0.043).CONCLUSIONS-TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality..

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality

Kim

Teague-Ross

Greenfield

et al. 2014

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

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“…The magnitude of the mortality difference between high-and low-activity regions was similar to, or larger than, the effect size of proven interventions, such as surfactant administration, antenatal corticosteroids, or centralization of perinatal care. [3][4][5] Although most analyses of outcomes are based on individual patient characteristics, the aim of this study was to determine the effect of regional practices on outcome. It is noteworthy that there are no Swedish guidelines regarding the immediate management of EPT infants, but regional guidelines do exist.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 This decrease in mortality can be attributed to advances in peri-and neonatal care, such as regionalization, antenatal steroids, monitoring during labor, improved ventilation techniques, surfactant administration, and a positive attitude to intervention by the perinatal team. [2][3][4][5][6][7] However, large variability in the intensity of perinatal care and outcome of EPT infants is reported between centers, regions, and countries providing comparative levels of care. 6,[8][9][10][11][12][13][14] Proactive care, conceptualized as a policy of providing a high intensity of care for all EPT births, including those occurring at the edge of viability, 6,15 may decrease the rate of stillbirth [15][16][17] and increase survival of infants born alive.…”

Section: What This Study Addsmentioning

confidence: 99%

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

et al. 2015

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, for the EXPRESS Study Group abstract OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (,27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22-to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA.CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

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“…This association likely has many causes, including differences in the adoption rate of evidence-based care (8), provider expertise/staffing models (7,9,10), and referral bias (11). Thus, various professional organizations are actively debating a tiered system of regionalization for patients with VDRF (12,13) that would be similar to existing systems in trauma and high-risk neonatology (14)(15)(16).…”

mentioning

confidence: 99%

Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

et al. 2017

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Rationale: Patients with ventilator-dependent respiratory failure have improved outcomes at centers with greater expertise; yet, most patients are not treated in such facilities. Efforts to align care for respiratory failure and hospital capability would necessarily require interhospital transfer.Objectives: To characterize the prevalence and the patient and hospital factors associated with interhospital transfer of adults residing in Florida with ventilator-dependent respiratory failure.Methods: We performed a retrospective, observational study using Florida Healthcare Cost and Utilization Project data. We selected patients 18 years of age and older with International Classification of Diseases, Ninth Revision, codes of respiratory failure and mechanical ventilation during 2012 and 2013, and we identified cohorts of patients that did and did not undergo interhospital transfer. We obtained patient sociodemographic and clinical variables and categorized hospitals into subtypes on the basis of patient volume and services provided: large, medium (nonprofit or for-profit), and small.Results: Interhospital transfer was our primary outcome measure. Patient sociodemographics, clinical variables, and hospital types were used as covariates. We identified 2,580 patients with ventilatordependent respiratory failure who underwent interhospital transfer. Overall, transfer was uncommon, with only 2.9% of patients being transferred. In a hierarchical model, age less than 65 years (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.77-2.45) and tracheostomy (OR, 3.19; 95% CI, 2.80-3.65) were associated with higher odds of transfer, whereas having Medicaid was associated with lower odds of transfer than having commercial insurance (OR, 0.65; 95% CI, 0.56-0.75). Additionally, care in medium-sized for-profit hospitals was associated with lower odds of transfer (OR, 1.37 vs. 2.70) than care in medium nonprofit hospitals, despite similar hospital characteristics. Conclusions:In Florida, interhospital transfer of patients with ventilator-dependent respiratory failure is uncommon and more likely among younger, commercially insured, medically resourceintensive patients. For-profit hospitals are less likely to transfer than nonprofit hospitals. In future studies, researchers should test for geographic variations and examine the clinical implications of selectivity in interhospital transfer of patients with ventilatordependent respiratory failure.

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Perinatal Regionalization for Very Low-Birth-Weight and Very Preterm Infants

Cited by 334 publications

References 57 publications

Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality

Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure

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