Skip to content Skip to navigation
University of Warwick
  • Study
  • |
  • Research
  • |
  • Business
  • |
  • Alumni
  • |
  • News
  • |
  • About

University of Warwick
Publications service & WRAP

Highlight your research

  • WRAP
    • Home
    • Search WRAP
    • Browse by Warwick Author
    • Browse WRAP by Year
    • Browse WRAP by Subject
    • Browse WRAP by Department
    • Browse WRAP by Funder
    • Browse Theses by Department
  • Publications Service
    • Home
    • Search Publications Service
    • Browse by Warwick Author
    • Browse Publications service by Year
    • Browse Publications service by Subject
    • Browse Publications service by Department
    • Browse Publications service by Funder
  • Help & Advice
University of Warwick

The Library

  • Login
  • Admin

The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England : retrospective population-based cohort study

Tools
- Tools
+ Tools

Watson, Samuel I., Arulampalam, Wiji, Petrou, Stavros, Marlow, Neil, Morgan, A. S., Draper, Elizabeth S., Santhakumaran, S. and Modi, N. (2014) The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England : retrospective population-based cohort study. BMJ Open, Volume 4 (Number 7). Article number e004856. doi:10.1136/bmjopen-2014-004856 ISSN 2044-6055.

[img] PDF
WRAP_Petrou_e004856.full.pdf - Published Version - Requires a PDF viewer.
Available under License Creative Commons Attribution Non-commercial.

Download (861Kb)
Official URL: http://dx.doi.org/10.1136/bmjopen-2014-004856

Request Changes to record.

Abstract

Objective:
To examine the effects of designation and volume of neonatal care at the hospital of birth on mortality and morbidity outcomes in very preterm infants in a managed clinical network setting.

Design:
A retrospective, population-based analysis of operational clinical data using adjusted logistic regression and instrumental variables (IV) analyses.

Setting:
165 National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing and Clinical Outcomes Project.

Participants: 20 554 infants born at <33 weeks completed gestation (17 995 born at 27–32 weeks; 2559 born at <27 weeks), admitted to neonatal care and either discharged or died, over the period 1 January 2009–31 December 2011.

Intervention:
Tertiary designation or high-volume neonatal care at the hospital of birth.

Outcomes:
Neonatal mortality, any in-hospital mortality, surgery for necrotising enterocolitis, surgery for retinopathy of prematurity, bronchopulmonary dysplasia and postmenstrual age at discharge.

Results:
Infants born at <33 weeks gestation and admitted to a high-volume neonatal unit at the hospital of birth were at reduced odds of neonatal mortality (IV regression odds ratio (OR) 0.70, 95% CI 0.53 to 0.92) and any in-hospital mortality (IV regression OR 0.68, 95% CI 0.54 to 0.85). The effect of volume on any in-hospital mortality was most acute among infants born at <27 weeks gestation (IV regression OR 0.51, 95% CI 0.33 to 0.79). A negative association between tertiary-level unit designation and mortality was also observed with adjusted logistic regression for infants born at <27 weeks gestation.

Conclusions:
High-volume neonatal care provided at the hospital of birth may protect against in-hospital mortality in very preterm infants. Future developments of neonatal services should promote delivery of very preterm infants at hospitals with high-volume neonatal units.

Item Type: Journal Article
Subjects: R Medicine > RJ Pediatrics
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions: Faculty of Social Sciences > Economics
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Neonatal nursing -- England, Pediatric nursing -- England, Newborn infants -- Care -- England, Neonatology -- England, Premature infants -- Hospital care
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: 7 July 2014
Dates:
DateEvent
7 July 2014Published
14 May 2014Accepted
14 January 2014Submitted
Volume: Volume 4
Number: Number 7
Article Number: Article number e004856
DOI: 10.1136/bmjopen-2014-004856
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 27 December 2015
Date of first compliant Open Access: 27 December 2015
Funder: National Institute of Health Research (NIHR), Great Britain. Department of Health (DoH), Danone, AbbVie, Abbott International, BLISS (Organisation), University of Warwick. Department of Economics
Grant number: RP-PG-0707-10010 (NIHR)

Request changes or add full text files to a record

Repository staff actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics

twitter

Email us: wrap@warwick.ac.uk
Contact Details
About Us