Brenna S Fullerton1, Eric A Sparks1, Kate A Morrow2, Erika M Edwards3, Roger F Soll3, Tom Jaksic1, Jeffrey D Horbar3, Biren P Modi4. 1. Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. 2. Vermont Oxford Network, Burlington, VT. 3. Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT. 4. Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: biren.modi@childrens.harvard.edu.
Abstract
PURPOSE: The objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality. METHODS: Mortality among 4328 VLBW neonates with surgical NEC born 2009-2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants). RESULTS: Mortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)). CONCLUSION: Transfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted.
PURPOSE: The objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality. METHODS: Mortality among 4328 VLBW neonates with surgical NEC born 2009-2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants). RESULTS: Mortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)). CONCLUSION: Transfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted.
Authors: Adrienne N Cobb; Yee M Wong; Sarah A Brownlee; Barbara A Blanco; Yoshiki Ezure; Heather N Paddock; Paul C Kuo; Anai N Kothari Journal: Am J Surg Date: 2016-11-09 Impact factor: 2.565
Authors: Katherine T Flynn-O'Brien; Morgan K Richards; Davene R Wright; Frederick P Rivara; Wren Haaland; Leah Thompson; Keith Oldham; Adam Goldin Journal: J Pediatr Surg Date: 2018-11-28 Impact factor: 2.545