| Title: |
Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy |
| Authors: |
Quinones Cardona, Vilmaris; Rao, Rakesh; Zaniletti, Isabella; Joe, Priscilla; Johnson, Yvette R.; DiGeronimo, Robert; Hamrick, Shannon E.; Lee, Kyong-Soon; Mietzsch, Ulrike; Natarajan, Girija; Peeples, Eric S.; Wu, Tai-Wei; Hossain, Tanzeema; Flibotte, John; Chandel, Amit; Distler, Amy; Shenberger, Jeffrey S.; Oghifobibi, Onome; Massaro, An N.; Dizon, Maria L. V.; Maitre, Nathalie; Mathur, Amit; Pallotto, Eugenia; Smith, Danielle; Speziale, Mark; Yanowitz, Toby; Brozanski, Beverly; Evans, Jacquelyn; Grover, Theresa; Murthy, Karna; Padula, Michael; Piazza, Anthony; Reber, Kristina; Short, Billie; Durand, David; Dykes, Francine; Asselin, Jeanette; Sullivan, Kevin; McKay, Victor; Limjoco, Jamie; Haack, Lori; Dereddy, Narenda; Wadhawan, Raj; Falciglia, Gustave; Rogers, Becky; Hansen, Anne; Welch, Cherrie; Haberman, Beth; Sysyn, Gregory; Birge, Nicole |
| Source: |
JAMA Network Open ; volume 6, issue 3, page e233770 ; ISSN 2574-3805 |
| Publisher Information: |
American Medical Association (AMA) |
| Publication Year: |
2023 |
| Description: |
Importance Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes. Objective To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE. Design, Setting, and Participants Retrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children’s hospitals participating in the Children’s Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022. Exposures Infants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles. Main Outcomes and Measures The main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared. Results Among the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P < .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P < .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high– or medium–hospitalization ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1001/jamanetworkopen.2023.3770 |
| Availability: |
https://doi.org/10.1001/jamanetworkopen.2023.3770; https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2802680/quinones_cardona_2023_oi_230149_1678732446.13404.pdf |
| Accession Number: |
edsbas.918D4B35 |
| Database: |
BASE |