Association of Hospital Resource Utilization with Neurodevelopmental Outcomes in Neonates with Hypoxic-Ischemic Encephalopathy

• Type of Material: Article
• Authors: Vilmaris Q Cardona, St. Christopher's Hospital for Children Philadelphia; Rakesh Rao, St. Louis Children's Hospital; Isabella Zaniletti, Children's Hospital Association; Priscilla Joe, UCSF Benioff Children's Hospital Oakland; Yvette R Johnson, Texas Christian University; Robert DiGeronimo, University of Washington; Shannon Hamrick, Emory University; Kyong-Soon Lee, Hospital for Sick Children University of Toronto; Ulrike Mietzsch, University of Washington; Girija Natarajan, Central Michigan University; Eric S Peeples, University of Nebraska Medical Center; Tai-Wei Wu, Keck School of Medicine of USC; Tanzeema Hossain, Children's Hospital Boston; John Flibotte, The Children's Hospital of Philadelphia; Amit Chandel, Wake Forest University School of Medicine; Amy Distler, St. Louis Children's Hospital; Jeffrey S Shenberger, Wake Forest University School of Medicine; Onome Oghifobibi, University of Pittsburgh Medical Center; An N Massaro, Childrens National Health System; Maria LV Dizon, Northwestern University Feinberg School of Medicine
• Language: English
• Date: 2023-03-21
• Publisher: JAMA Network Open.
• Publication Version: Final Published Version
• Copyright Statement: 2023 Quinones Cardona V et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2023.3770
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 6
• Issue: 3
• Start Page: e233770
• End Page: e233770
• Keywords: Child; Hospitals; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Cohort Studies; Hospitalization; Retrospective Studies; Infant
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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 cost centers and death or NDI. High- and medium-EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95%CI, 0.16-0.57]; medium vs low: OR, 0.29 [95%CI, 0.13-0.62]). High- and medium-laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95%CI, 1.19-4.66]; medium vs low: OR, 1.93 [95%CI, 1.07-3.47]). High-antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95%CI, 1.51-9.18]; medium vs low: OR, 1.56 [95%CI, 0.71- 3.42]). CONCLUSIONS AND RELEVANCE Hospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.