title: Hospital transfers and patterns of mortality in very low birth weight neonates with surgical necrotizing enterocolitis.
abstract: OBJECTIVE
  The objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality.
  
  
  METHODS
  Mortality among 4328 VLBW neonates with surgical NEC born 2009-2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants).
  
  
  RESULTS
  Mortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)).
  
  
  CONCLUSIONS
  Transfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted.
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Brenna S
authors.initials: BS
authors.lastname: Fullerton
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Vermont Oxford Network, Burlington, VT.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Morrow
authors.affiliation: Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT.
authors.forename: Erika M
authors.initials: EM
authors.lastname: Edwards
authors.affiliation: Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT.
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.affiliation: Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Horbar
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: biren.modi@childrens.harvard.edu.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000401:mortality* / Q000601:surgery; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality* / Q000601:surgery; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010360:Patient Transfer; D012044:Regression Analysis
keywords: Hospital transfer; NICU level; Necrotizing enterocolitis; VLBW