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Vilmaris Quinones Cardona, MD, St Christopher’s Hospital for Children, Drexel University College of Medicine, 160 E Erie Ave, Philadelphia, PA 19134. Email: vq23@drexel.edu

Drs Massaro and Zaniletti had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Quinones Cardona and Rao contributed equally. Drs Massaro and Dizon contributed equally. Concept and design: Quinones Cardona, Rao, Zaniletti, DiGeronimo, Hamrick, Lee, Peeples, Wu, Flibotte, Massaro, Dizon. Acquisition, analysis, or interpretation of data: Quinones Cardona, Rao, Zaniletti, Joe, Johnson, Lee, Mietzsch, Natarajan, Peeples, Wu, Hossain, Chandel, Distler, Shenberger, Oghifobibi, Massaro, Dizon. Drafting of the manuscript: Quinones Cardona, Rao, Joe, DiGeronimo, Dizon. Critical revision of the manuscript for important intellectual content: Rao, Zaniletti, Johnson, DiGeronimo, Hamrick, Lee, Mietzsch, Natarajan, Peeples, Wu, Hossain, Flibotte, Chandel, Distler, Shenberger, Oghifobibi, Massaro, Dizon. Statistical analysis: Zaniletti. Administrative, technical, or material support: Johnson, Hamrick, Hossain, Massaro. Supervision: Quinones Cardona, Rao, Wu, Shenberger, Massaro, Dizon.

We would like to acknowledge the contributions of Nathalie Maitre, MD, Amit Mathur, MD, Eugenia Pallotto, MD, Danielle Smith, MD, Mark Speziale, MD, and Toby Yanowitz, MD, in data collection. Beverly Brozanski, MD, Jacquelyn Evans, MD, Theresa Grover, MD, Karna Murthy, MD, Michael Padula, MD, Eugenia Pallotto, MD, Anthony Piazza, MD, Kristina Reber, MD, and Billie Short, MD, and ex-officio David Durand, MD, Francine Dykes, MD, Jeanette Asselin, MS, are executive members of the Children’s Hospitals Neonatal Consortium, Inc, who developed and manage the Children’s Hospitals Neonatal Database. We are indebted to the following Children’s Hospitals Neonatal Consortium participating institutions that serve the infants and their families; these institutions (and their site sponsors) also have invested in and continue to participate in the Children’s Hospital’s Neonatal Database: Alfred I. duPont Hospital for Children, Wilmington, Delaware (Kevin Sullivan, MD), All Children’s Hospital Johns Hopkins Medicine, St Petersburg, Florida (Victor McKay, MD), American Family Hospital, Madison, Wisconsin (Jamie Limjoco, MD, Lori Haack, MD), Advent Health for Children, Orlando, Florida (Narenda Dereddy, MD, Raj Wadhawan, MD), Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois (Karna Murthy, MD, Gustave Falciglia, MD), Arkansas Children’s Hospital (Becky Rogers, MD), Boston Children’s Hospital, Boston, Massachusetts (Anne Hansen, MD), Brenner Children’s Hospital, Winston-Salem, North Carolina (Cherrie Welch, MD), Cincinnati Children’s Hospital, Cincinnati, Ohio (Beth Haberman, MD), Children’s Healthcare of Atlanta at Egleston, Atlanta, Georgia (Anthony Piazza, MD), Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia (Gregory Sysyn, MD), Children’s Hospital and Medical Center, Omaha, Nebraska (Nicole Birge, MD), Children’s Hospital Colorado, Denver (Theresa Grover, MD), Children’s Hospital of Orange County, Orange, California (Michel Mikhael, MD, Irfan Ahmad, MD), Children’s Hospital of Philadelphia (Michael Padula, MD, David Munson, MD), Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania (Toby Yanowitz, MD), Children’s Hospital of Wisconsin, Milwaukee, Wisconsin (Michael Uhing, MD, Ankur Datta, MD), Children’s Medical Center Dallas, TX (Rashmin Savani, MD, Luc Brion, MD), Children’s Mercy Hospitals and Clinics, Kansas City, Missouri (Julie Weiner, MD), Children’s National Medical Center, Washington, DC (Billie Short, MD, Lamia Soghier, MD), Children’s of Alabama, Birmingham, Alabama (Carl Coghill, MD, Allison Black, MD), Children’s Hospital of Los Angeles, Los Angeles, California (Steven Chin, MD, Rachel Chapman, MD), Children’s Hospital of Michigan, Detroit, Michigan (Girija Natarajan, MD), Connecticut Children’s Medical Center, Hartford, Connecticut (AnneMarie Golioto, MD), Cook Children’s Medical Center, Fort Worth, Texas (Jonathan Nedrelow, MD, Annie Chi, MD, Yvette Johnson, MD), Hospital for Sick Children, Toronto, Ontario, Canada (Kyong-Soon Lee, MD), Le Bonheur Children’s Hospital, Memphis, Tennessee (Mark Weems, MD), Nationwide Children’s Hospital, Columbus, Ohio (Kristina Reber, MD), Nemours Children’s Hospital, Orlando, Florida (Aaron Weiss, MD), Oklahoma Children’s Hospital, Oklahoma City, Oklahoma (Trent Tibble, MD), Primary Children’s Hospital, Salt Lake City, Utah (Con Yee Ling, MD, Shrena Patel, MD), Rady Children’s Hospital, San Diego, California (Mark Speziale, MD, Brian Lane, MD, Laurel Moyer, MD), Riley Children’s, Indianapolis, Indiana (William Engle, MD, Lora Simpson, MD, Gregory Sokol, MD), Seattle Children’s Hospital, Seattle, Washington (Elizabeth Jacobsen-Misbe, MD, Robert DiGeronimo, MD), Stead Family Children’s Hospital, Iowa City, Iowa (Julie Lindower, MD), St Christopher’s Hospital for Children, Philadelphia, Pennsylvania (Vilmaris Quinones Cardona, MD), St Louis Children’s Hospital, St Louis, Missouri (Beverly Brozanski, MD, Rakesh Rao, MD), Texas Children’s Hospital, Houston, Houston, Texas (Gautham Suresh, MD, Lakshmi Khatakam, MD), UCSF Benioff Children’s Hospital Oakland, Oakland, California (Art D’Harlingue, MD, Priscilla Joe, MD).

Dr Flibotte reported receiving personal fees from Janssen Global Services LLC and personal fees from Momenta Pharmaceuticals Inc during the conduct of the study. No other disclosures were reported.

Subject:

Keywords:

  • Infant, Newborn
  • Infant
  • Humans
  • Child
  • Retrospective Studies
  • Hypoxia-Ischemia, Brain
  • Cohort Studies
  • Hospitalization
  • Hospitals

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

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Journal Title:

JAMA Network Open

Volume:

Volume 6, Number 3

Publisher:

, Pages e233770-e233770

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

2023 Quinones Cardona V et al. JAMA Network Open.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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