Neonatal intensive care unit characteristics affect the incidence of severe intraventricular hemorrhage.
OBJECTIVE
The incidence of intraventricular hemorrhage (IVH), adjusted for known risk factors, varies across neonatal intensive care units (NICU)s. The effect of NICU characteristics on this variation is unknown. The objective was to assess IVH attributable risks at both patient and NICU levels.


METHODS
Subjects were <33 weeks' gestation, <4 days old on admission in the Canadian Neonatal Network database (all infants admitted in 1996-97 to 17 NICUs). The variation in severe IVH rates was analyzed using Bayesian hierarchical modeling for patient level and NICU level factors.


RESULTS
Of 3772 eligible subjects, the overall crude incidence rates of grade 3-4 IVH was 8.3% (NICU range 2.0-20.5%). Male gender, extreme preterm birth, low Apgar score, vaginal birth, outborn birth, and high admission severity of illness accounted for 30% of the severe IVH rate variation; admission day therapy-related variables (treatment of acidosis and hypotension) accounted for an additional 14%. NICU characteristics, independent of patient level risk factors, accounted for 31% of the variation. NICUs with high patient volume and high neonatologist/staff ratio had lower rates of severe IVH.


CONCLUSIONS
The incidence of severe IVH is affected by NICU characteristics, suggesting important new strategies to reduce this important adverse outcome.
Synnes
Anne R
AR
Department of Pediatrics, University of British Columbia, Canada.
Macnab
Ying C
YC
Qiu
Zhenguo
Z
Ohlsson
Arne
A
Gustafson
Paul
P
Dean
Charmaine B
CB
Lee
Shoo K
SK
D000208:Acute Disease; D001499:Bayes Theorem; D002170:Canada / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D002552:Cerebral Ventricles / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000458:organization & administration*; D008297:Male; D047928:Premature Birth / Q000473:pathology