Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy
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Published:2023-03-21
Issue:3
Volume:6
Page:e233770
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Quinones Cardona Vilmaris1, Rao Rakesh2, Zaniletti Isabella3, Joe Priscilla4, Johnson Yvette R.5, DiGeronimo Robert6, Hamrick Shannon E.7, Lee Kyong-Soon8, Mietzsch Ulrike6, Natarajan Girija9, Peeples Eric S.10, Wu Tai-Wei11, Hossain Tanzeema12, Flibotte John13, Chandel Amit14, Distler Amy2, Shenberger Jeffrey S.14, Oghifobibi Onome15, Massaro An N.16, Dizon Maria L. V.17, Maitre Nathalie18, Mathur Amit18, Pallotto Eugenia18, Smith Danielle18, Speziale Mark18, Yanowitz Toby18, Brozanski Beverly18, Evans Jacquelyn18, Grover Theresa18, Murthy Karna18, Padula Michael18, Piazza Anthony18, Reber Kristina18, Short Billie18, Durand David18, Dykes Francine18, Asselin Jeanette18, Sullivan Kevin18, McKay Victor18, Limjoco Jamie18, Haack Lori18, Dereddy Narenda18, Wadhawan Raj18, Falciglia Gustave18, Rogers Becky18, Hansen Anne18, Welch Cherrie18, Haberman Beth18, Sysyn Gregory18, Birge Nicole18, Grover THeresa18, Mikhael Michel18, Ahmad Irfan18, Munson David18, Uhing Michael18, Datta Ankur18, Savani Rashmin18, Brion Luc18, Weiner Julie18, Soghier Lamia18, Coghill Carl18, Black Allison18, Chin Steven18, Chapman Rachel18, Golioto AnneMarie18, Nedrelow Jonathan18, Chi Annie18, Johnson Yvette18, Weems Mark18, Weiss Aaron18, Tripple Trent18, Ling Con Yee18, Patel Shrena18, Lane Brian18, Moyer Laurel18, Engle William18, Simpson Lora18, Sokol Gregory18, Jacobsen-Misbe Elizabeth18, Lindower Julie18, Suresh Gautham18, Khatakam Lakshmi18, D'Harlingue Art18,
Affiliation:
1. St Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania 2. St Louis Children’s Hospital, St Louis, Missouri 3. Children’s Hospital Association, Kansas City, Kansas 4. UCSF Benioff Children’s Hospital, Oakland, California 5. Cook’s Children’s Medical Center, Department of Pediatrics, Texas Christian University Medical School, Fort Worth 6. Seattle Children’s Hospital, University of Washington, Seattle 7. Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia 8. The Hospital for Sick Children, Toronto, Ontario, Canada 9. Children’s Hospital of Michigan, Central Michigan University, Detroit 10. University of Nebraska Medical Center, Omaha 11. Children’s Hospital of Los Angeles, USC Keck School of Medicine, Los Angeles, California 12. Boston Children’s Hospital, Boston, Massachusetts 13. Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 14. Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston-Salem, North Carolina 15. University of Pittsburg Medical Center, Pittsburg, Pennsylvania 16. Childrens National Health Systems, Washington, DC 17. Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois 18. for the Children’s Hospitals Neonatal Consortium
Abstract
ImportanceIntercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.ObjectiveTo 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 ParticipantsRetrospective 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.ExposuresInfants 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 MeasuresThe main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared.ResultsAmong 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 RelevanceHospitalization 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.
Publisher
American Medical Association (AMA)
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