title: Surfactant use for premature infants with respiratory distress syndrome in three New York city hospitals: discordance of practice from a community clinician consensus standard.
abstract: OBJECTIVE
  To assess concordance with a locally developed standard of care for premature infants with respiratory distress syndrome (RDS) for whom the standard recommends surfactant treatment within 2 h of birth, and to examine the association between clinical, demographic, and hospital characteristics with discordance from the standard.
  
  
  METHODS
  Retrospective cohort study of 773 infants weighing < or =1750 g born in any of the three New York City hospitals between 1999 and 2002.
  
  
  RESULTS
  227 of the 773 infants (29%) met criteria for treatment according to the standard. Of these, 37% received surfactant by 2 h. By 4 h, 70% of infants who met the standard received surfactant. White infants were more likely to receive surfactant by 4 h (85%) than African American (61%) or Latino infants (67%). Multivariable logistic regression revealed significant odds ratios predicting discordance from the relaxed criteria (4 h) for African American race (4.10, 95% confidence interval: 1.30 to 13.00), 100 g of birth weight (odds ratio: 1.22, 95% confidence interval: 1.10 to 1.34), and hospital of birth.
  
  
  CONCLUSIONS
  Many infants with RDS failed to receive surfactant replacement therapy at 2 and 4 h after birth. African Americans and those born larger were less likely to receive surfactant. If these data can be generalized, there is a large opportunity to reduce infant morbidity from RDS and to reduce racial/ethnic disparities in birth outcomes by increasing the rate and speed with which surfactant is delivered to these infants.
authors.affiliation: Department of Health Policy, Mount Sinai School of Medicine, New York City, NY, USA. elizabeth.howell@msnyuhealth.org
authors.forename: E A
authors.initials: EA
authors.lastname: Howell
authors.forename: I
authors.initials: I
authors.lastname: Holzman
authors.forename: L C
authors.initials: LC
authors.lastname: Kleinman
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: M R
authors.initials: MR
authors.lastname: Chassin
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D008485:Medical Audit; D009519:New York City; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000208:ethnology*; D012189:Retrospective Studies
chemical_list: D011663:Pulmonary Surfactants