Brian C King1, Joseph Hagan2, Troy Richardson3, Jay Berry4, Jonathan L Slaughter5. 1. Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA. kingbc2@upmc.edu. 2. Newborn Center, Texas Children's Hospital, Houston, TX, USA. 3. Children's Hospital Association, Lenexa, KS, USA. 4. Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 5. Center for Perinatal Research, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
Abstract
OBJECTIVE: Estimate hospital variation in echocardiography (echo) among very preterm infants. STUDY DESIGN: Retrospective cohort study of very preterm (<32 weeks) infants discharged between 2012 and 2019 from US children's hospitals. Echo exposure was identified using daily billing, and hospital variation was estimated after adjustment for illness severity. Variation in very early echo use (<3 days of life) was compared to exposure to treatment of a patent ductus arteriosus (PDA), and other practice patterns. RESULTS: 27,498 subjects across 39 children's hospitals were included. Very early echo use had the greatest hospital variation (3-34%). Increasing very early echo use was not associated with PDA treatment (p = 0.93), but was associated with nitric oxide (p < 0.01) and vasoactive medications (p < 0.01). CONCLUSIONS: Hospital variation in echo use among preterm infants was greatest in the first few days of life and was associated with increasing nitric oxide and vasoactive medication use. The impact of this variation on clinical outcomes is uncertain and warrants further investigation.
OBJECTIVE: Estimate hospital variation in echocardiography (echo) among very preterm infants. STUDY DESIGN: Retrospective cohort study of very preterm (<32 weeks) infants discharged between 2012 and 2019 from US children's hospitals. Echo exposure was identified using daily billing, and hospital variation was estimated after adjustment for illness severity. Variation in very early echo use (<3 days of life) was compared to exposure to treatment of a patent ductus arteriosus (PDA), and other practice patterns. RESULTS: 27,498 subjects across 39 children's hospitals were included. Very early echo use had the greatest hospital variation (3-34%). Increasing very early echo use was not associated with PDA treatment (p = 0.93), but was associated with nitric oxide (p < 0.01) and vasoactive medications (p < 0.01). CONCLUSIONS: Hospital variation in echo use among preterm infants was greatest in the first few days of life and was associated with increasing nitric oxide and vasoactive medication use. The impact of this variation on clinical outcomes is uncertain and warrants further investigation.
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Authors: Brian C King; Troy Richardson; Ravi M Patel; Henry C Lee; Nicolas A Bamat; Matthew Hall; Jonathan L Slaughter Journal: J Perinatol Date: 2021-06-01 Impact factor: 2.521