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  • 1
    Online Resource
    Online Resource
    Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants
    American Academy of Pediatrics (AAP) ; 2013
    In:  Pediatrics Vol. 132, No. 1 ( 2013-07-01), p. e175-e184
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 132, No. 1 ( 2013-07-01), p. e175-e184
    Abstract: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants. METHODS: We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during 2006–2009. The primary outcomes of early mortality (≤12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs & lt;25 weeks and ≥25 weeks. RESULTS: Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs & lt;25 weeks, and 1% to 11% and 7% to 26% for GAs ≥25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants & lt;25 weeks. For infants ≥25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates. CONCLUSIONS: Center intervention rates explain a portion of the center variation in mortality, especially for infants born at & lt;25 weeks’ GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA ≥25 weeks these differences account for only a small part of the variation in mortality.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2012-3707
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2013
    detail.hit.zdb_id: 1477004-0
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  • 2
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    Online Resource
    Anaerobic Antimicrobial Therapy After Necrotizing Enterocolitis in VLBW Infants
    American Academy of Pediatrics (AAP) ; 2015
    In:  Pediatrics Vol. 135, No. 1 ( 2015-01-01), p. e117-e125
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 135, No. 1 ( 2015-01-01), p. e117-e125
    Abstract: To evaluate the effect of anaerobic antimicrobial therapy for necrotizing enterocolitis (NEC) on clinical outcomes in very low birth weight (≤1500 g) infants. METHODS: We identified very low birth weight infants with NEC from 348 US NICUs from 1997 to 2012. Anaerobic antimicrobial therapy was defined by antibiotic exposure on the first day of NEC. We matched (1:1) infants exposed to anaerobic antimicrobial therapy with infants who were not exposed by using a propensity score stratified by NEC severity (medical and surgical). The primary composite outcome was in-hospital death or intestinal stricture. We assessed the relationship between anaerobic antimicrobial therapy and outcome by using a conditional logistic regression on the matched cohort. RESULTS: A total of 1390 infants exposed to anaerobic antimicrobial therapy were matched with 1390 infants not exposed. Mean gestational age and birth weight were 27 weeks and 946 g, respectively, and were similar in both groups. We found no significant difference in the combined outcome of death or strictures, but strictures as a single outcome were more common in the anaerobic antimicrobial therapy group (odds ratio 1.73; 95% confidence interval, 1.11–2.72). Among infants with surgical NEC, mortality was less common with anaerobic antimicrobial therapy (odds ratio 0.71; 95% confidence interval, 0.52–0.95). CONCLUSIONS: Anaerobic antimicrobial therapy was not associated with the composite outcome of death or strictures but was associated with an increase in intestinal strictures. This higher incidence of intestinal strictures may be explained by the fact that death is a competing outcome for intestinal strictures, and mortality was slightly lower in the anaerobic cohort. Infants with surgical NEC who received anaerobic antimicrobial therapy had lower mortality.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2014-2141
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
    detail.hit.zdb_id: 1477004-0
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  • 3
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    Online Resource
    Approach to Infants Born at 22 to 24 Weeks’ Gestation: Relationship to Outcomes of More-Mature Infants
    American Academy of Pediatrics (AAP) ; 2012
    In:  Pediatrics Vol. 129, No. 6 ( 2012-06-01), p. e1508-e1516
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 129, No. 6 ( 2012-06-01), p. e1508-e1516
    Abstract: We sought to determine if a center’s approach to care of premature infants at the youngest gestational ages (22–24 weeks’ gestation) is associated with clinical outcomes among infants of older gestational ages (25–27 weeks’ gestation). METHODS: Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks’ gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included use of antenatal corticosteroids, cesarean delivery, and resuscitation. The primary outcome was death before postnatal day 120 for infants of 25 to 27 weeks’ gestation. Secondary outcomes were the combined outcomes of death or a number of morbidities associated with prematurity. RESULTS: Our study included 3631 infants 22 to 24 weeks’ gestation and 5227 infants 25 to 27 weeks’ gestation. Among the 22- to 24-week infants, use of antenatal corticosteroids ranged from 28% to 100%, cesarean delivery from 13% to 65%, and resuscitation from 30% to 100% by center. Centers with higher rates of antenatal corticosteroid use in 22- to 24-week infants had reduced rates of death, death or retinopathy of prematurity, death or late-onset sepsis, death or necrotizing enterocolitis, and death or neurodevelopmental impairment in 25- to 27-week infants. CONCLUSIONS: This study suggests that physicians’ willingness to provide care to extremely low gestation infants as measured by frequency of use of antenatal corticosteroids is associated with improved outcomes for more-mature infants.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2011-2216
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2012
    detail.hit.zdb_id: 1477004-0
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  • 4
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    Congenital Diaphragmatic Hernia: Updates and Outcomes
    American Academy of Pediatrics (AAP) ; 2011
    In:  NeoReviews Vol. 12, No. 8 ( 2011-08-01), p. e439-e452
    Details
    In: NeoReviews, American Academy of Pediatrics (AAP), Vol. 12, No. 8 ( 2011-08-01), p. e439-e452
    Abstract: Management of congenital diaphragmatic hernia (CDH) remains challenging. Despite advances in technologic and therapeutic strategies such as high-frequency mechanical ventilation, inhaled nitric oxide (iNO), and delayed surgical repair, the condition continues to carry a substantial mortality risk. In recent years, with increasing prenatal identification of fetuses affected by CDH, more effort has been directed toward strategies allowing in utero intervention, with the goal of improving survival. Unfortunately, a universally successful fetal treatment for CDH remains elusive. Over the past several decades, collective knowledge has markedly increased regarding the range of short- and long-term morbidities experienced by CDH survivors, and medical care has evolved as understanding of the disease has progressed. Affected patients demand and deserve a multidisciplinary approach, both in the inpatient arena and follow-up setting, with experts in neonatology, surgery, pulmonology, cardiology, and neurodevelopment working together to optimize outcomes. This article reviews the basic pathophysiology behind CDH, describes recent updates in the field, and outlines the long-term outcomes for these fascinating and complex patients.
    Type of Medium: Online Resource
    ISSN: 1526-9906
    URL: Article
    DOI: 10.1542/neo.12-8-e439
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2011
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