title: Does hospital transfer predict mortality in very low birth weight infants requiring surgery for necrotizing enterocolitis?
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is a leading cause of infant mortality, and the most common reason for emergent surgery in very low birth weight (VLBW, < 1,500 g) infants. We investigated whether transfer for higher level of surgical care affects mortality in this population.
  
  
  METHODS
  VLBW infants who underwent NEC surgery were reviewed retrospectively from the California Patient Discharge Linked Birth Cohort Database (1999-2007). Transfer for emergent operation was defined as surgery ≤2 days after transfer. Mortality was analyzed with multivariate logistic regression.
  
  
  RESULTS
  Overall, 1,272 VLBW infants with surgical NEC were identified, with a 39% mortality. Transfer for operative care occurred in 406 (32%) infants. Unadjusted mortality was not increased for infants who were transferred compared with not transferred (37% vs. 40%; P = .25). Adjusted mortality for infants transferred for operative care did not differ from those who received operative care at their primary neonatal intensive care unit (odds ratio 0.75, 95% confidence interval 0.42-1.32). Lower birth weight, lack of prenatal care, peritoneal drainage as sole surgical intervention, and pulmonary interstitial emphysema/pulmonary hemorrhage were associated with increased odds of mortality (P < .05).
  
  
  CONCLUSIONS
  VLBW infants with surgical NEC do not demonstrate increased risk of mortality when transferred emergently for operative care. Future efforts must engage health professionals caring for this vulnerable population to maximize resource allocation and safety.
authors: Division of Pediatric Surgery-Department of Surgery, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7098, USA.
authors: Lorraine I
authors: LI
authors: Kelley-Quon
authors: Chi-Hong
authors: CH
authors: Tseng
authors: Andrew
authors: A
authors: Scott
authors: Howard C
authors: HC
authors: Jen
authors: Kara L
authors: KL
authors: Calkins
authors: Stephen B
authors: SB
authors: Shew
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality* / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies