Intercenter differences in bronchopulmonary dysplasia or death among very low birth weight infants

Academic Article

Abstract

  • OBJECTIVES: To determine (1) the magnitude of clustering of bronchopulmonary dysplasia (36 weeks) or death (the outcome) across centers of the Eunice Kennedy Shriver National Institute of Child and Human Development National Research Network, (2) the infant-level variables associated with the outcome and estimate their clustering, and (3) the center-specific practices associated with the differences and build predictive models. METHODS: Dataonneonates with a birth weight of <1250 g from the clusterrandomized benchmarking trial were used to determine the magnitude of clustering of theoutcomeaccording to alternating logistic regression by using pairwiseoddsratioandpredictive modeling. Clinical variables associated with the outcome were identified by using multivariate analysis. The magnitude of clustering was then evaluated after correction for infant-level variables. Predictive models were developed by using center-specific and infant-level variables for data from 2001 2004 and projected to 2006. RESULTS: In 2001-2004, clustering of bronchopulmonary dysplasia/ death was significant (pairwise odds ratio: 1.3; P<.001) and increased in 2006 (pairwise odds ratio: 1.6; overall incidence: 52%; range across centers: 32%-74%); center rates were relatively stable over time. Variables that varied according to center and were associated with increased risk of outcome included lower body temperature at NICU admission, use of prophylactic indomethacin, specific drug therapy on day 1, and lack of endotracheal intubation. Center differences remained significant even after correction for clustered variables. CONCLUSION: Bronchopulmonary dysplasia/death rates demonstrated moderate clustering according to center. Clinical variables associated with the outcome were also clustered. Center differences after correction of clustered variables indicate presence of as-yet unmeasured center variables. Copyright © 2011 by the American Academy of Pediatrics.
  • Published In

  • Pediatrics  Journal
  • Digital Object Identifier (doi)

    Author List

  • Ambalavanan N; Walsh M; Bobashev G; Das A; Levine B; Carlo WA; Higgins RD
  • Volume

  • 127
  • Issue

  • 1