Center Differences and Outcomes of Extremely Low Birth Weight Infants

Betty R. Vohr, Linda L. Wright, Anna M. Dusick, Rebecca Perritt, W. Kenneth Poole, Jon E. Tyson, Jean J. Steichen, Charles R Bauer, Deanne E. Wilson-Costello, Linda C. Mayes

Research output: Contribution to journalArticle

221 Citations (Scopus)

Abstract

Objective. Previous multicenter studies have shown significant center differences in neonatal characteristics and morbidities. This study evaluated center differences in outcome at 18 to 22 months among extremely low birth weight (ELBW; 401-1000 g) infants after adjusting for demographics and antenatal interventions, and it identified neonatal interventions associated with outcome differences. Methods. We assessed the outcome of 2478 liveborn infants who were admitted in 1993 and 1994 to the 12 centers of the Neonatal Research Network of the National Institute of Child Health and Human Development; 1483 (60%) infants survived to 18 to 22 months, and 1151 (78%) had comprehensive evaluations. Logistic regression analyses were performed to identify center differences and the association of 4 neonatal interventions-active resuscitation, postnatal steroids, ventilator treatment for ≤27 days, and full enteral feedings ≤24 days-with adverse outcomes (cerebral palsy, low Bayley scores, and neurodevelopmental impairment [NDI]), after adjusting for demographics and antenatal interventions. Results. Using bivariate analyses, significant center differences were identified for mortality, antenatal and postnatal interventions, social and environmental variables, neonatal morbidities, and neurodevelopmental outcomes for the 12 centers. After adjustment for maternal and infant demographics and antenatal interventions, the percentage of ELBW infants who had died or had NDI at 18 to 22 months ranged from 52% to 85%. Active resuscitation and postnatal steroids were associated with increases of NDI of 11.8% and 19.3%, whereas shorter ventilation support and shorter time to achieve full enteral feeds were associated with decreases in NDI of 20.7% and 17.3%, respectively. Conclusion. There are large and disturbing differences among centers in outcomes at 18 to 22 months after adjusting for demographic and antenatal interventions. Center differences in postnatal interventions associated with differences in outcome can provide hypotheses for testing in clinical trials to improve outcome.

Original languageEnglish
Pages (from-to)781-789
Number of pages9
JournalPediatrics
Volume113
Issue number4 I
DOIs
StatePublished - Apr 1 2004

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Extremely Low Birth Weight Infant
Demography
Resuscitation
Steroids
National Institute of Child Health and Human Development (U.S.)
Morbidity
Low Birth Weight Infant
Enteral Nutrition
Cerebral Palsy
Mechanical Ventilators
Multicenter Studies
Small Intestine
Ventilation
Logistic Models
Regression Analysis
Mothers
Clinical Trials
Mortality
Research

Keywords

  • Bayley
  • Center differences
  • Cerebral palsy
  • Developmental outcome
  • Extremely low birth weight
  • Follow-up studies
  • Neurologic outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Vohr, B. R., Wright, L. L., Dusick, A. M., Perritt, R., Poole, W. K., Tyson, J. E., ... Mayes, L. C. (2004). Center Differences and Outcomes of Extremely Low Birth Weight Infants. Pediatrics, 113(4 I), 781-789. https://doi.org/10.1542/peds.113.4.781

Center Differences and Outcomes of Extremely Low Birth Weight Infants. / Vohr, Betty R.; Wright, Linda L.; Dusick, Anna M.; Perritt, Rebecca; Poole, W. Kenneth; Tyson, Jon E.; Steichen, Jean J.; Bauer, Charles R; Wilson-Costello, Deanne E.; Mayes, Linda C.

In: Pediatrics, Vol. 113, No. 4 I, 01.04.2004, p. 781-789.

Research output: Contribution to journalArticle

Vohr, BR, Wright, LL, Dusick, AM, Perritt, R, Poole, WK, Tyson, JE, Steichen, JJ, Bauer, CR, Wilson-Costello, DE & Mayes, LC 2004, 'Center Differences and Outcomes of Extremely Low Birth Weight Infants', Pediatrics, vol. 113, no. 4 I, pp. 781-789. https://doi.org/10.1542/peds.113.4.781
Vohr BR, Wright LL, Dusick AM, Perritt R, Poole WK, Tyson JE et al. Center Differences and Outcomes of Extremely Low Birth Weight Infants. Pediatrics. 2004 Apr 1;113(4 I):781-789. https://doi.org/10.1542/peds.113.4.781
Vohr, Betty R. ; Wright, Linda L. ; Dusick, Anna M. ; Perritt, Rebecca ; Poole, W. Kenneth ; Tyson, Jon E. ; Steichen, Jean J. ; Bauer, Charles R ; Wilson-Costello, Deanne E. ; Mayes, Linda C. / Center Differences and Outcomes of Extremely Low Birth Weight Infants. In: Pediatrics. 2004 ; Vol. 113, No. 4 I. pp. 781-789.
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abstract = "Objective. Previous multicenter studies have shown significant center differences in neonatal characteristics and morbidities. This study evaluated center differences in outcome at 18 to 22 months among extremely low birth weight (ELBW; 401-1000 g) infants after adjusting for demographics and antenatal interventions, and it identified neonatal interventions associated with outcome differences. Methods. We assessed the outcome of 2478 liveborn infants who were admitted in 1993 and 1994 to the 12 centers of the Neonatal Research Network of the National Institute of Child Health and Human Development; 1483 (60{\%}) infants survived to 18 to 22 months, and 1151 (78{\%}) had comprehensive evaluations. Logistic regression analyses were performed to identify center differences and the association of 4 neonatal interventions-active resuscitation, postnatal steroids, ventilator treatment for ≤27 days, and full enteral feedings ≤24 days-with adverse outcomes (cerebral palsy, low Bayley scores, and neurodevelopmental impairment [NDI]), after adjusting for demographics and antenatal interventions. Results. Using bivariate analyses, significant center differences were identified for mortality, antenatal and postnatal interventions, social and environmental variables, neonatal morbidities, and neurodevelopmental outcomes for the 12 centers. After adjustment for maternal and infant demographics and antenatal interventions, the percentage of ELBW infants who had died or had NDI at 18 to 22 months ranged from 52{\%} to 85{\%}. Active resuscitation and postnatal steroids were associated with increases of NDI of 11.8{\%} and 19.3{\%}, whereas shorter ventilation support and shorter time to achieve full enteral feeds were associated with decreases in NDI of 20.7{\%} and 17.3{\%}, respectively. Conclusion. There are large and disturbing differences among centers in outcomes at 18 to 22 months after adjusting for demographic and antenatal interventions. Center differences in postnatal interventions associated with differences in outcome can provide hypotheses for testing in clinical trials to improve outcome.",
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