Hospital Variation in Nitric Oxide Use for Premature Infants

Abstract

OBJECTIVE: To describe inter-center hospital variation in inhaled nitric oxide (iNO) administration to infants born prior to 34 weeks' gestation at US children's hospitals. METHODS: This was a retrospective cohort study using the Pediatric Health Information System to determine the frequency, age at first administration, and length of iNO use among 22 699 consecutive first admissions of unique <34 weeks’ gestation infants admitted to 37 children’s hospitals from January 1, 2007, through December 31, 2010. RESULTS: A total of 1644 (7.2%) infants received iNO during their hospitalization, with substantial variation in iNO use between hospitals (range across hospitals: 0.5%–26.2%; P < .001). The age at which iNO was started varied by hospital (mean: 20.0 days; range: 6.0–65.1 days, P < .001), as did the duration of therapy (mean: 13.1 days; range: 1.0–31.1 days; P < .001). Preterm infants who received iNO were less likely to survive (36.3% mortality vs 8.3%; odds ratio: 6.27; P < .001). The association between the use of iNO and mortality persists in propensity score–adjusted analyses controlling for demographic factors and diagnoses associated with the use of iNO (odds ratio: 3.79; P < .0001). CONCLUSIONS: iNO practice patterns in preterm infants varied widely among institutions. Infants who received iNO were less likely to survive, suggesting that iNO is used in infants already at high risk of death. Adherence to National Institutes of Health consensus guidelines may decrease variation in iNO use.