Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units.
OBJECTIVE
This multisite study sought to identify (1) any differences in admission risk (defined by gestational age and illness severity) among neonatal intensive care units (NICUs) and (2) obstetric antecedents of newborn illness severity.


METHODS
Data on 1476 babies born at a gestational age of less than 32 weeks in 6 perinatal centers were abstracted prospectively. Newborn illness severity was measured with the Score for Neonatal Acute Physiology. Regression models were constructed to predict scores as a function of perinatal risk factors.


RESULTS
The sites differed by several obstetric case-mix characteristics. Of these, only gestational age, small for gestational age. White race, and severe congenital anomalies were associated with higher scores. Antenatal corticosteroids, low Apgar scores, and neonatal hypothermia also affected illness severity. At 2 sites, higher mean severity could not be explained by case mix.


CONCLUSIONS
Obstetric events and perinatal practices affect newborn illness severity. These risk factors differ among perinatal centers and are associated with elevated illness severity at some sites. Outcomes of NICU care may be affected by antecedent events and perinatal practices.
Richardson
D K
DK
Joint Program in Neonatology (Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, and Children's Hospital), Harvard Medical School, Boston, MA 02215, USA. richardson@neonatology.bidmc.harvard.edu
Shah
B L
BL
Frantz
I D
ID
Bednarek
F
F
Rubin
L P
LP
McCormick
M C
MC
D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D001034:Apgar Score; D000013:Congenital Abnormalities; D003953:Diagnosis-Related Groups / Q000145:classification; D005865:Gestational Age; D006801:Humans; D007035:Hypothermia / Q000150:complications; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000145:classification* / Q000209:etiology*; D007363:Intensive Care Units, Neonatal; D016014:Linear Models; D008404:Massachusetts; D011237:Predictive Value of Tests; D011295:Prenatal Care; D011446:Prospective Studies; D044469:Racial Groups; D012237:Rhode Island; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids
D000893:Anti-Inflammatory Agents; D013256:Steroids