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.

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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:	Date Event 7 July 2014 Published 14 May 2014 Accepted 14 January 2014 Submitted
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)

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