PMID- 36648939 OWN - NLM STAT- MEDLINE DCOM- 20230308 LR - 20240118 IS - 2168-6211 (Electronic) IS - 2168-6203 (Print) IS - 2168-6203 (Linking) VI - 177 IP - 3 DP - 2023 Mar 1 TI - Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants. PG - 278-285 LID - 10.1001/jamapediatrics.2022.5213 [doi] AB - IMPORTANCE: A higher level of care improves outcomes in extremely and very preterm infants, yet the impact of neonatal intensive care unit (NICU) level on moderate and late preterm (MLP) care quality is unknown. OBJECTIVE: To examine the association between NICU type and care quality in MLP (30-36 weeks' gestation) and extremely and very preterm (25-29 weeks' gestation) infants. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a prospective analysis of 433 814 premature infants born in 465 US hospitals between January 1, 2016, and December 31, 2020, without anomalies and who survived more than 12 hours and were transferred no more than once. Data were from the Vermont Oxford Network all NICU admissions database. EXPOSURES: NICU types were defined as units with ventilation restrictions without surgery (type A with restrictions, similar to American Academy of Pediatrics [AAP] level 2 NICUs), without surgery (type A) and with surgery not requiring cardiac bypass (type B, similar to AAP level 3 NICUs), and with all surgery (type C, similar to AAP level 4 NICUs). MAIN OUTCOMES AND MEASURES: The primary outcome was gestational age (GA)-specific composite quality measures using Baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) for extremely and very preterm infants and an adapted MLP quality measure for MLP infants. Secondary outcomes were individual component measures of each scale. Composite scores were standardized observed minus expected scores, adjusted for patient characteristics, averaged, and expressed with a mean of 0 and SD of 1. Between May 2021 and October 2022, Kruskal-Wallis tests were used to compare scores by NICU type. RESULTS: Among the 376 219 MLP (204 181 [54.3%] male, 172 038 [45.7%] female; mean [SD] GA, 34.2 [1.7] weeks) and 57 595 extremely and very preterm (30 173 [52.4%] male, 27 422 [47.6%] female; mean [SD] GA, 27.7 [1.4] weeks) infants included, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs, and 24.4% in type C NICUs. The MLP infants had lower MLP-QM scores in type C NICUs (median [IQR]: type A with restrictions, 0.4 [-0.1 to 0.8]; type A, 0.4 [-0.4 to 0.9]; type B, 0.1 [-0.7 to 0.7]; type C, -0.7 [-1.6 to 0.4]; P < .001). No significant differences were found in extremely and very preterm Baby-MONITOR scores by NICU type. In type C NICUs, MLP infants had lower scores in no extreme length of stay and change-in-weight z score. CONCLUSIONS AND RELEVANCE: In this cohort study, composite quality scores were lower for MLP infants in type C NICUs, whereas extremely and very preterm composite quality scores were similar across NICU types. Policies facilitating care for MLP infants at NICUs with less complex subspecialty services may improve care quality delivered to this prevalent, at-risk population. FAU - Salazar, Elizabeth G AU - Salazar EG AD - Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. AD - Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania. FAU - Handley, Sara C AU - Handley SC AD - Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. AD - Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania. AD - Perelman School of Medicine at the University of Pennsylvania, Philadelphia. FAU - Greenberg, Lucy T AU - Greenberg LT AD - Vermont Oxford Network, Burlington, Vermont. AD - Department of Mathematics and Statistics, The University of Vermont, Burlington. FAU - Edwards, Erika M AU - Edwards EM AD - Vermont Oxford Network, Burlington, Vermont. AD - Department of Mathematics and Statistics, The University of Vermont, Burlington. AD - Department of Pediatrics, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington. FAU - Lorch, Scott A AU - Lorch SA AD - Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. AD - Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania. AD - Perelman School of Medicine at the University of Pennsylvania, Philadelphia. LA - eng GR - T32 HL098054/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - JAMA Pediatr JT - JAMA pediatrics JID - 101589544 SB - IM MH - Infant MH - Infant, Newborn MH - Humans MH - Male MH - Female MH - Child MH - *Intensive Care Units, Neonatal MH - Infant, Premature MH - Cohort Studies MH - Intensive Care, Neonatal MH - Gestational Age MH - *Infant, Premature, Diseases MH - Quality of Health Care PMC - PMC9857785 COIS- Conflict of Interest Disclosures: Dr Handley reported receiving grants from the American Academy of Pediatrics Neonatal Resuscitation Program outside the submitted work. Dr Edwards reported receiving grants from the Vermont Oxford Network during the conduct of the study. No other disclosures were reported. EDAT- 2023/01/18 06:00 MHDA- 2023/03/09 06:00 PMCR- 2024/01/17 CRDT- 2023/01/17 11:35 PHST- 2023/01/18 06:00 [pubmed] PHST- 2023/03/09 06:00 [medline] PHST- 2023/01/17 11:35 [entrez] PHST- 2024/01/17 00:00 [pmc-release] AID - 2800549 [pii] AID - poi220085 [pii] AID - 10.1001/jamapediatrics.2022.5213 [doi] PST - ppublish SO - JAMA Pediatr. 2023 Mar 1;177(3):278-285. doi: 10.1001/jamapediatrics.2022.5213.