Hospital volume and mortality of very low-birthweight infants in South America.

OBJECTIVE: To assess the effects of hospital volume of very low-birthweight (VLBW) infants on in-hospital mortality of VLBW and very preterm birth (VPB) infants in South America. DATA SOURCES/STUDY
SETTING: Birth-registry data for infants born in 1982-2008 at VLBW or very preterm in 66 hospitals in Argentina, Brazil, and Chile.
DESIGN: Regression analyses that adjust for several individual-level demographic, socioeconomic, and health factors; hospital-level characteristics; and country-fixed effects are employed. DATA COLLECTION/EXTRACTION
METHODS: Physicians interviewed mothers before hospital discharge and abstracted hospital medical records using similar methods at all hospitals. PRINCIPAL
FINDINGS: Volume has significant nonlinear beneficial effects on VLBW and VPB in-hospital survival. The largest survival benefits--more than 80 percent decrease in mortality rates--are with volume increases from low to medium or medium-high levels (from ≤ 25 to 72 infants annually) with significantly lower incremental benefits thereafter. The cumulative volume effects are maximized at the 121-144 annual VLBW infant range--about 90 percent decrease in mortality rates compared to <25 VLBW infants annually.
CONCLUSIONS: Increasing the access of pregnancies at-risk of VLBW and VPB to medium- or high-volume hospitals up to 144 VLBW infants per year may substantially improve in-hospital infant survival in the study countries. © Health Research and Educational Trust.