Download PDF
Am J Perinatol 2014; 31(08): 659-666
DOI: 10.1055/s-0033-1356484
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Influence of Neonatal Practice Variation on Outcomes of Late Preterm Birth

Sofia Aliaga
1   Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Kim Boggess
2   Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Thomas S. Ivester
2   Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Wayne A. Price
1   Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

08 July 2013

05 August 2013

Publication Date:
10 September 2013 (online)

    Permissions and Reprints

Abstract

Objective Examine variation in short-term outcomes of late preterm births (340/7–366/7 weeks) between a university teaching hospital, teaching community hospital, and nonteaching community hospital.

Study Design Review of maternal and newborn data from a random sample of late preterm births at three hospitals in North Carolina from 2008 to 2009. Outcomes included length of stay, neonatal intensive care unit (NICU) admission, respiratory support, antibiotic exposure, phototherapy exposure, and hypoglycemia.

Results We analyzed data from 331 singleton late preterm newborns: 93 (28.1%) from a university teaching hospital, 110 (33.2%) from a teaching community hospital, and 128 (38.7%) from a nonteaching community hospital. Mean gestational age did not vary between hospitals. NICU admission, exposure to antibiotics, and phototherapy were more common at the university teaching hospital after controlling for risk factors, yet length of stay was shortest at the university teaching hospital and longest at the teaching community hospital after adjustment.

Conclusion Practice variation contributes to differences in length of stay, NICU admission, and exposure to antibiotics and phototherapy among late preterm newborns. Differences in practice during the birth hospitalization may affect outcomes and health care utilization (e.g., readmission) after discharge.

Keywords

late preterm - practice variation - neonatal care

Comment to this article:

Dr. Sofia Aliaga InterviewAm J Perinatol 2014; 31(08): e1-e1
DOI: 10.1055/s-0034-1383899

 

  • References

  • 1 Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary Data for 2009. In: National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics; 2010
    Google Scholar
  • 2 Engle WA, Tomashek KM, Wallman C ; Committee on Fetus and Newborn, American Academy of Pediatrics. “Late-preterm” infants: a population at risk. Pediatrics 2007; 120 (6) 1390-1401
    CrossrefPubMedGoogle Scholar
  • 3 Zupancic JA, Richardson DK. Characterization of the triage process in neonatal intensive care. Pediatrics 1998; 102 (6) 1432-1436
    CrossrefPubMedGoogle Scholar
  • 4 Profit J, Zupancic JA, McCormick MC , et al. Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom. Arch Dis Child Fetal Neonatal Ed 2006; 91 (4) F245-F250
    CrossrefPubMedGoogle Scholar
  • 5 Roblin DW, Richardson DK, Thomas E , et al. Variation in the use of alternative levels of hospital care for newborns in a managed care organization. Health Serv Res 2000; 34 (7) 1535-1553
    PubMedGoogle Scholar
  • 6 Lee SK, McMillan DD, Ohlsson A , et al. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics 2000; 106 (5) 1070-1079
    CrossrefPubMedGoogle Scholar
  • 7 Spitzer AR, Kirkby S, Kornhauser M. Practice variation in suspected neonatal sepsis: a costly problem in neonatal intensive care. J Perinatol 2005; 25 (4) 265-269
    CrossrefPubMedGoogle Scholar
  • 8 Altman M, Vanpée M, Cnattingius S, Norman M. Moderately preterm infants and determinants of length of hospital stay. Arch Dis Child Fetal Neonatal Ed 2009; 94 (6) F414-F418
    CrossrefPubMedGoogle Scholar
  • 9 Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108 (4) 928-933
    CrossrefPubMedGoogle Scholar
  • 10 Whyte RK. Neonatal management and safe discharge of late and moderate preterm infants. Semin Fetal Neonatal Med 2012; 17 (3) 153-158
    CrossrefPubMedGoogle Scholar
  • 11 Gyamfi-Bannerman C, Fuchs KM, Young OM, Hoffman MK. Nonspontaneous late preterm birth: etiology and outcomes. Am J Obstet Gynecol 2011; 205 (5) e1-e6
    CrossrefPubMedGoogle Scholar
  • 12 American Academy of Pediatrics Committee on Fetus And Newborn. Levels of neonatal care. Pediatrics 2012; 130 (3) 587-597
    CrossrefPubMedGoogle Scholar
  • 13 Lubow JM, How HY, Habli M, Maxwell R, Sibai BM. Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol 2009; 200 (5) e30-e33
    CrossrefPubMedGoogle Scholar
  • 14 Hibbard JU, Wilkins I, Sun L , et al; Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA 2010; 304 (4) 419-425
    CrossrefPubMedGoogle Scholar
  • 15 Melamed N, Klinger G, Tenenbaum-Gavish K , et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol 2009; 114 (2 Pt 1) 253-260
    CrossrefPubMedGoogle Scholar
  • 16 Kitsommart R, Janes M, Mahajan V , et al. Outcomes of late-preterm infants: a retrospective, single-center, Canadian study. Clin Pediatr (Phila) 2009; 48 (8) 844-850
    CrossrefPubMedGoogle Scholar
  • 17 Escobar GJ, Greene JD, Hulac P , et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90 (2) 125-131
    CrossrefPubMedGoogle Scholar
  • 18 Escobar GJ, Joffe S, Gardner MN, Armstrong MA, Folck BF, Carpenter DM. Rehospitalization in the first two weeks after discharge from the neonatal intensive care unit. Pediatrics 1999; 104 (1) e2
    CrossrefPubMedGoogle Scholar
  • 19 Jain S, Cheng J. Emergency department visits and rehospitalizations in late preterm infants. Clin Perinatol 2006; 33 (4) 935-945 , abstract xi
    CrossrefPubMedGoogle Scholar
  • 20 Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics 2004; 114 (2) 372-376
    CrossrefPubMedGoogle Scholar
  • 21 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111 (1) 35-41
    CrossrefPubMedGoogle Scholar
  • 22 Vachharajani AJ, Dawson JG. Short-term outcomes of late preterms: an institutional experience. Clin Pediatr (Phila) 2009; 48 (4) 383-388
    CrossrefPubMedGoogle Scholar
  • 23 Teune MJ, Bakhuizen S, Gyamfi Bannerman C , et al. A systematic review of severe morbidity in infants born late preterm. Am J Obstet Gynecol 2011; 205 (4) e1-e9
    CrossrefPubMedGoogle Scholar
  • 24 Kuzniewicz MW, Escobar GJ, Newman TB. Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use. Pediatrics 2009; 124 (4) 1031-1039
    CrossrefPubMedGoogle Scholar
  • 25 Petersen JR, Okorodudu AO, Mohammad AA, Fernando A, Shattuck KE. Association of transcutaneous bilirubin testing in hospital with decreased readmission rate for hyperbilirubinemia. Clin Chem 2005; 51 (3) 540-544
    CrossrefPubMedGoogle Scholar
  • 26 Eggert LD, Wiedmeier SE, Wilson J, Christensen RD. The effect of instituting a prehospital-discharge newborn bilirubin screening program in an 18-hospital health system. Pediatrics 2006; 117 (5) e855-e862
    CrossrefPubMedGoogle Scholar
  • 27 Bastek JA, Sammel MD, Paré E, Srinivas SK, Posencheg MA, Elovitz MA. Adverse neonatal outcomes: examining the risks between preterm, late preterm, and term infants. Am J Obstet Gynecol 2008; 199 (4) e1-e8
    PubMedGoogle Scholar
  • 28 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114 (1) 297-316
    CrossrefPubMedGoogle Scholar
  • 29 Goyal NK, Fager C, Lorch SA. Adherence to discharge guidelines for late-preterm newborns. Pediatrics 2011; 128 (1) 62-71
    CrossrefPubMedGoogle Scholar