Hospitals Vary In Treatment Of 22-24 Week Preterm Infants

MedicalResearch.com Interview with:
Mr. Matthew A. Rysavy, B.S and Edward Bell, MD
Department of Pediatrics, University of Iowa
Iowa City, IA

Medical Research: What is the background for this study? What are the main findings?

Response: We were interested in understanding reasons for differences in outcomes among extremely preterm infants among hospitals.  This has been shown in many studies.  We found that differences among hospitals in whether treatment was initiated for infants born at very early gestations (22, 23, 24 weeks’ gestation) accounted for a lot of the variation in hospital-level outcomes at these gestational ages.

Medical Research: What should clinicians and patients take away from your report?

Response: In the editorial accompanying our study, Professor Marlow writes: “Information on survival, morbidity, and policies regarding active intervention should be available to assist parents in making an informed choice about transfer to a specialist hospital, if feasible, and the level of intervention provided after birth.”  Ultimately, the care of individual infants must be decided by the parents and doctors based on the best available information. We hope that, by unpacking some of the differences in hospital outcomes, our study sheds some light on what this information is and how to better obtain it.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: There are still many important questions about differences in hospital outcomes that need further study.  For example, in our study, among hospitals that initiated treatment for 100% of infants born at 24 weeks of gestation, rates of risk-adjusted survival still varied from 42 to 70%.  It seems important to understand other reasons for the variation in outcomes among hospitals.

Also, there are important questions about how to better make decisions about treatment. The prognosis of extremely preterm infants is often fairly uncertain, and physicians and families have to make decisions based on very limited information.  Gestational age alone is not the best indicator of prognosis.  Some infants born at 22 weeks survive and do well and many others do not; likewise, some but not all, infants born at 26 weeks or later do well.  This is why it is important not to use gestational age as the sole criterion for making decisions about treatment.  We need to understand better issues related to the prognosis of extremely preterm infants to improve their care.

Citation:

Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants

Matthew A. Rysavy, B.S., Lei Li, Ph.D., Edward F. Bell, M.D., Abhik Das, Ph.D., Susan R. Hintz, M.D., Barbara J. Stoll, M.D., Betty R. Vohr, M.D., Waldemar A. Carlo, M.D., Seetha Shankaran, M.D., Michele C. Walsh, M.D., Jon E. Tyson, M.D., M.P.H., C. Michael Cotten, M.D., M.H.S., P. Brian Smith, M.D., M.P.H., M.H.S., Jeffrey C. Murray, M.D., Tarah T. Colaizy, M.D., M.P.H., Jane E. Brumbaugh, M.D., and Rosemary D. Higgins, M.D. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

N Engl J Med 2015; 372:1801-1811 May 7, 2015

DOI: 10.1056/NEJMoa1410689

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MedicalResearch.com Interview with: Mr. Matthew A. Rysavy, B.S and Edward Bell, MD (2015). Hospitals Vary In Treatment Of 22-24 Week Preterm Infants 

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