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. 1999 Apr;89(4):511–516. doi: 10.2105/ajph.89.4.511

Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units.

D K Richardson 1, B L Shah 1, I D Frantz 3rd 1, F Bednarek 1, L P Rubin 1, M C McCormick 1
PMCID: PMC1508909  PMID: 10191793

Abstract

OBJECTIVES: This multisite study sought to identify (1) any differences in admission risk (defined by gestational age and illness severity) among neonatal intensive care units (NICUs) and (2) obstetric antecedents of newborn illness severity. METHODS: Data on 1476 babies born at a gestational age of less than 32 weeks in 6 perinatal centers were abstracted prospectively. Newborn illness severity was measured with the Score for Neonatal Acute Physiology. Regression models were constructed to predict scores as a function of perinatal risk factors. RESULTS: The sites differed by several obstetric case-mix characteristics. Of these, only gestational age, small for gestational age. White race, and severe congenital anomalies were associated with higher scores. Antenatal corticosteroids, low Apgar scores, and neonatal hypothermia also affected illness severity. At 2 sites, higher mean severity could not be explained by case mix. CONCLUSIONS: Obstetric events and perinatal practices affect newborn illness severity. These risk factors differ among perinatal centers and are associated with elevated illness severity at some sites. Outcomes of NICU care may be affected by antecedent events and perinatal practices.

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Selected References

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  1. Berman S., Tanasijevic M. J., Alvarez J. G., Ludmir J., Lieberman E., Richardson D. K. Racial differences in the predictive value of the TDx fetal lung maturity assay. Am J Obstet Gynecol. 1996 Jul;175(1):73–77. doi: 10.1016/s0002-9378(96)70253-3. [DOI] [PubMed] [Google Scholar]
  2. Brenner W. E., Edelman D. A., Hendricks C. H. A standard of fetal growth for the United States of America. Am J Obstet Gynecol. 1976 Nov 1;126(5):555–564. doi: 10.1016/0002-9378(76)90748-1. [DOI] [PubMed] [Google Scholar]
  3. Catlin E. A., Carpenter M. W., Brann B. S., 4th, Mayfield S. R., Shaul P. W., Goldstein M., Oh W. The Apgar score revisited: influence of gestational age. J Pediatr. 1986 Nov;109(5):865–868. doi: 10.1016/s0022-3476(86)80715-6. [DOI] [PubMed] [Google Scholar]
  4. Crowley P., Chalmers I., Keirse M. J. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol. 1990 Jan;97(1):11–25. doi: 10.1111/j.1471-0528.1990.tb01711.x. [DOI] [PubMed] [Google Scholar]
  5. Hack M., Horbar J. D., Malloy M. H., Tyson J. E., Wright E., Wright L. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network. Pediatrics. 1991 May;87(5):587–597. [PubMed] [Google Scholar]
  6. Horbar J. D. The Vermont-Oxford Neonatal Network: integrating research and clinical practice to improve the quality of medical care. Semin Perinatol. 1995 Apr;19(2):124–131. doi: 10.1016/s0146-0005(05)80032-1. [DOI] [PubMed] [Google Scholar]
  7. Hulsey T. C., Alexander G. R., Robillard P. Y., Annibale D. J., Keenan A. Hyaline membrane disease: the role of ethnicity and maternal risk characteristics. Am J Obstet Gynecol. 1993 Feb;168(2):572–576. doi: 10.1016/0002-9378(93)90496-6. [DOI] [PubMed] [Google Scholar]
  8. Kaaresen P. I., Døhlen G., Fundingsrud H. P., Dahl L. B. The use of CRIB (clinical risk index for babies) score in auditing the performance of one neonatal intensive care unit. Acta Paediatr. 1998 Feb;87(2):195–200. doi: 10.1080/08035259850157660. [DOI] [PubMed] [Google Scholar]
  9. Leviton A., Kuban K. C., Pagano M., Allred E. N., Van Marter L. Antenatal corticosteroids appear to reduce the risk of postnatal germinal matrix hemorrhage in intubated low birth weight newborns. Pediatrics. 1993 Jun;91(6):1083–1088. [PubMed] [Google Scholar]
  10. Padbury J. F., Ervin M. G., Polk D. H. Extrapulmonary effects of antenatally administered steroids. J Pediatr. 1996 Feb;128(2):167–172. doi: 10.1016/s0022-3476(96)70384-0. [DOI] [PubMed] [Google Scholar]
  11. Richardson D. K., Gray J. E., Gortmaker S. L., Goldmann D. A., Pursley D. M., McCormick M. C. Declining severity adjusted mortality: evidence of improving neonatal intensive care. Pediatrics. 1998 Oct;102(4 Pt 1):893–899. doi: 10.1542/peds.102.4.893. [DOI] [PubMed] [Google Scholar]
  12. Richardson D. K., Gray J. E., McCormick M. C., Workman K., Goldmann D. A. Score for Neonatal Acute Physiology: a physiologic severity index for neonatal intensive care. Pediatrics. 1993 Mar;91(3):617–623. [PubMed] [Google Scholar]
  13. Richardson D. K., Phibbs C. S., Gray J. E., McCormick M. C., Workman-Daniels K., Goldmann D. A. Birth weight and illness severity: independent predictors of neonatal mortality. Pediatrics. 1993 May;91(5):969–975. [PubMed] [Google Scholar]
  14. Richardson D. K., Tarnow-Mordi W. Neonatal illness severity and new insights into perinatal audit. Acta Paediatr. 1998 Feb;87(2):134–135. doi: 10.1080/08035259850157543. [DOI] [PubMed] [Google Scholar]
  15. Richardson D. K., Torday J. S. Racial differences in predictive value of the lecithin/sphingomyelin ratio. Am J Obstet Gynecol. 1994 May;170(5 Pt 1):1273–1278. doi: 10.1016/s0002-9378(94)70141-5. [DOI] [PubMed] [Google Scholar]
  16. Verloove-Vanhorick S. P., Verwey R. A., Brand R., Gravenhorst J. B., Keirse M. J., Ruys J. H. Neonatal mortality risk in relation to gestational age and birthweight. Results of a national survey of preterm and very-low-birthweight infants in the Netherlands. Lancet. 1986 Jan 11;1(8472):55–57. doi: 10.1016/s0140-6736(86)90713-0. [DOI] [PubMed] [Google Scholar]
  17. Wirtschafter D. D., Jones K. R., Thomas J. T. Using health care outcomes to improve patient care in the NICU. Jt Comm J Qual Improv. 1994 Feb;20(2):57–65. doi: 10.1016/s1070-3241(16)30044-x. [DOI] [PubMed] [Google Scholar]

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