Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants

Felix Miedaner; Kristina Langhammer; Christian Enke; Wolfgang Göpel; Angela Kribs; Anika Nitzsche; Rainer Riedel; Christiane Woopen; Ludwig Kuntz; Bernhard Roth

doi:10.1038/s41372-017-0036-0

Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants

Felix Miedaner^*, Kristina Langhammer, Christian Enke, Wolfgang Göpel, Angela Kribs, Anika Nitzsche, Rainer Riedel, Christiane Woopen, Ludwig Kuntz, Bernhard Roth

^*Corresponding author for this work

Department of Pediatric and Adolescent Medicine

University of Cologne

8 Citations (Scopus)

Abstract

Objective: To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants. Study design: A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants. Results: After risk-adjustment and accounting for other NICU characteristics, infants in low-volume NICUs were at higher risk of IVH, ROP and PVL. However, the initial effect of volume on process measures (growth velocity, administration of antenatal steroids) disappeared. Conclusion: Volume can only partially explain differences in the treatment quality of VLBWs. The underlying organizational mechanisms should be considered to improve the quality of care.

Original language	English
Journal	Journal of Perinatology
Volume	38
Issue number	4
Pages (from-to)	402-410
Number of pages	9
ISSN	0743-8346
DOIs	https://doi.org/10.1038/s41372-017-0036-0
Publication status	Published - 01.04.2018

Funding

The study was funded by the German Federal Ministry of Education and Research (Grant No.: 01GY1152), participating hospitals received financial allowance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 5 Gender Equality

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title = "Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants",

abstract = "Objective: To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants. Study design: A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants. Results: After risk-adjustment and accounting for other NICU characteristics, infants in low-volume NICUs were at higher risk of IVH, ROP and PVL. However, the initial effect of volume on process measures (growth velocity, administration of antenatal steroids) disappeared. Conclusion: Volume can only partially explain differences in the treatment quality of VLBWs. The underlying organizational mechanisms should be considered to improve the quality of care.",

author = "Felix Miedaner and Kristina Langhammer and Christian Enke and Wolfgang G{\"o}pel and Angela Kribs and Anika Nitzsche and Rainer Riedel and Christiane Woopen and Ludwig Kuntz and Bernhard Roth",

note = "Funding Information: The study was funded by the German Federal Ministry of Education and Research (Grant No.: 01GY1152), participating hospitals received financial allowance Publisher Copyright: {\textcopyright} 2017 Nature America, Inc., part of Springer Nature. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",

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AU - Miedaner, Felix

AU - Langhammer, Kristina

AU - Enke, Christian

AU - Göpel, Wolfgang

AU - Kribs, Angela

AU - Nitzsche, Anika

AU - Riedel, Rainer

AU - Woopen, Christiane

AU - Kuntz, Ludwig

AU - Roth, Bernhard

N1 - Funding Information: The study was funded by the German Federal Ministry of Education and Research (Grant No.: 01GY1152), participating hospitals received financial allowance Publisher Copyright: © 2017 Nature America, Inc., part of Springer Nature. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objective: To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants. Study design: A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants. Results: After risk-adjustment and accounting for other NICU characteristics, infants in low-volume NICUs were at higher risk of IVH, ROP and PVL. However, the initial effect of volume on process measures (growth velocity, administration of antenatal steroids) disappeared. Conclusion: Volume can only partially explain differences in the treatment quality of VLBWs. The underlying organizational mechanisms should be considered to improve the quality of care.

AB - Objective: To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants. Study design: A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants. Results: After risk-adjustment and accounting for other NICU characteristics, infants in low-volume NICUs were at higher risk of IVH, ROP and PVL. However, the initial effect of volume on process measures (growth velocity, administration of antenatal steroids) disappeared. Conclusion: Volume can only partially explain differences in the treatment quality of VLBWs. The underlying organizational mechanisms should be considered to improve the quality of care.

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Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants

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UN SDGs

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