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Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants

Journal of Perinatology volume 38, pages 402–410 (2018)Cite this article

Subjects

Abstract

Objective

To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants.

Study design

A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants.

Results

After risk-adjustment and accounting for other NICU characteristics, infants in low-volume NICUs were at higher risk of IVH, ROP and PVL. However, the initial effect of volume on process measures (growth velocity, administration of antenatal steroids) disappeared.

Conclusion

Volume can only partially explain differences in the treatment quality of VLBWs. The underlying organizational mechanisms should be considered to improve the quality of care.

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Acknowledgements

The study was funded by the German Federal Ministry of Education and Research (Grant No.: 01GY1152), participating hospitals received financial allowance. The following hospitals and investigators participated in the study (in alphabetical order): Department of Neonatology, Klinikum Frankfurt (Oder): Cornelia Ast, MD; Department of Neonatology, Children’s Hospital, Marienhospital Bottrop gGmbH: Sezgin Ata, MD; Children’s Hospital, St. Vincenz-Krankenhaus GmbH: Björn Beckers, MD; Department of Neonatology and Pediatric Intensive Care, University Medical Center Greifswald: Anke Beyersdorff, MD; Department of Neonatology, Charité University Medical Center Berlin: Christoph Bührer, MD; Children’s Hospital, Klinikum Oberberg GmbH: Salem El-Hamid, MD; Children’s University Hospital, Johannes Wesling Klinikum Minden: Bernhard Erdlenbruch, MD; Department of Neonatology, GFO Kliniken Bonn: St. Marien Hospital: Werner Garbe, MD; Department of Neonatology, Dr. von Hauner Kinderspital, Klinikum der Universität München: O. Genzel-Boroviczény, MD; Department of Neonatology, Christophorus-Kliniken Coesfeld: Hubert Gerleve, MD; Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, Marienhospital Witten: Baham Gharavi, MD; Department of Neonatology, Children’s Hospital Lübeck, University Hospital Schleswig-Holstein: Wolfgang Göpel, MD; Department of Neonatology, St. Marien- und St. Annastiftskrankenhaus: Birgit Görtz, MD; Department of Neonatology and Pediatric Intensive Care, University Hospital Halle, Martin Luther University Halle: Roland Haase, MD; Department of Neonatology, Children’s Hospital, Diakoniekrankenhaus Bad Kreuznach: Edmondo Hammond, MD; Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, Helios Klinikum Krefeld: Peter Heister, MD; Department of Neonatology, Children’s Hospital, University of Witten/Herdecke, Helios University Hospital Wuppertal: Michael Heldmann, MD; Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, University Hospital of Freiburg: Roland Hentschel, MD; Department of Neonatology, Children’s Hospital St. Marien, Landshut: Reinhard Herterich, MD; Department of Neonatology, Children’s Hospital, Krankenhaus St. Elisabeth und St. Barbara Halle (Saale) GmbH: Claudia Heß, MD; Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, Klinikum Itzehoe: Georg Hillebrand, MD; Children’s Hospital, Gesundheitszentrum Rheine, Mathias-Spital: Hans-Georg Hoffmann, MD; Children’s Hospital, Evangelisches Krankenhaus Lippstadt: Thomas Hofmann, MD; Department of Neonatology, Heinrich-Heine-University Düsseldorf: Thomas Höhn, MD; Children’s Hospital, Klinikum Leverkusen gGmbH: Peter Jahn, MD; Children’s Hospital, Evangelisches Waldkrankenhaus Spandau, Berlin: Frank Jochum, MD; Children’s Hospital, OVGU University Magdeburg: Gerhard Jorch, MD; Department of Neonatology Ostbayern, Children’s Hospital, Kliniken Dritter Orden gGmbh Passau: Matthias Keller, MD; Children’s Hospital, Bethlehem Gesundheitszentrum Stolberg gGmbH: Heiner Kentrup, MD; Department of Neonatology, University of Regensburg, Klinik St. Hedwig, Krankenhaus Barmherzige Brüder: Jochen Kittel, MD; Children’s Hospital, Helios Dr. Horst Schmidt Kliniken Wiesbaden: Markus Knuf, MD; Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, Klinikum Links der Weser gGmbH: Hans Thorsten Körner, MD; Department of Neonatology, Städtisches Klinikum Karlsruhe gGmbH: Alexander Krauth, MD; Department of Neonatology, Children’s Hospital, University Hospital of Cologne: Angela Kribs, MD; Department of Neonatology, University Children’s Hospital Göttingen: Helmut Küster, MD; Department of Neonatology, Children’s Hospital, DRK Kliniken Berlin Westend: Arpad von Moers, MD; Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn: Andreas Müller, MD; Children’s Hospital, Klinikum Kassel: Dirk Müller, MD; Department of Neonatology, Children’s Hospital, Klinikum Memmingen: Ralf Pallacks, MD; Department of Neonatology and Pediatric Intensive Care, DRK Kinderklinik Siegen: Markus Pingel, MD; Department of Neonatology, Children's Hospital, Klinikum Fulda: Reinald Repp, MD; Children’s Hospital, Vivantes Klinikum Neukölln: Rainer Rossi, MD; Department of Neonatology, Children’s Hospital, Katholisches Karl-Leisner-Klinikum gGmbH, St.-Antonius-Hospital, Kleve: Jochen Rübo, MD; Children’s University Hospital, Paracelsius Medizinische Privatuniversität, Klinikum Nürnberg Süd: Stefan Schäfer, MD; Children’s Hospital, St. Joseph-KH Berlin: Antje Schlesinger, MD; Department of Neonatology, Children’s Hospital, University Hospital of Frankfurt: Rolf L. Schlößer, MD; Children’s Hospital, Städtisches Klinikum Dresden/Neustadt: Stefan Schmidt, MD; Department of Neonatology, Children’s Hospital, Klinikum Esslingen GmbH: Christian von Schnakenburg, MD; Department of Neonatology Nordostbayern, St. Marien, Amberg: Alexander Schnelke, MD; Children’s Hospital, Stauferklinikum Schwäbisch Gmünd: Birgit Schwander, MD; Department of Neonatology and Pediatric Intensive Care, Children’s Hospital, Klinikum Worms gGmbH: Heino Skopnik, MD; Children’s Hospital, Harzklinikum Dorothea Christiane Erxleben: Dieter Sontheimer, MD; Department of Neonatology, Children’s Hospital, Klinikum Herford: Uwe Spille, MD; Children’s Hospital, Klinikum Mutterhaus der Borromäerinnen: Wolfgang Thomas, MD; Children’s Hospital, University of Erlangen-Nürnberg: Hans Georg Topf, MD; Department of Neonatology, Children’s Hospital, Klinikum Singen: Andreas Trotter, MD; Department of Neonatology and Pediatric Intensive Care Medicine, Asklepios Klinik Sankt Augustin: Beatrix Wiebe, MD; Department of Neonatology and Pediatric Intensive Care Medicine, Klinikum Aschaffenburg: Christian Wieg, MD; Children’s Hospital, Caritas Hospital Bad Mergentheim: Christian Willaschek, MD; Department of Neonatology, DONAUISAR Klinikum Deggendorf: Michael Welsch, MD; Department of Neonatology and Pediatric Intensive Care, Altonaer Kinderkrankenhaus gGmbH: Axel von der Wense, MD; Department of Neonatology, Children’s Hospital, Carl-Thiem-Klinikum Cottbus gGmbH: Ulrike Wetzel, MD; Department of Neonatology, Main-Kinzig-Kliniken: Manuel Wilhelm, MD; Department of Neonatology, Children’s Hospital Bamberg: Alfons Wolf, MD; Department of General Pediatrics and Neonatology, University Hospital Saarland: Caroline Wollny.

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Authors and Affiliations

  1. Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany

    Felix Miedaner & Ludwig Kuntz

  2. Department of Neonatology and Pediatric Intensive Care, University Hospital of Cologne, Cologne, Germany

    Kristina Langhammer & Angela Kribs

  3. Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres) and Research Unit Ethics, Medical Faculty, University Clinic Cologne, Cologne, Germany

    Christian Enke & Christiane Woopen

  4. Department of Pediatrics, University of Lübeck, Lübeck, Germany

    Wolfgang Göpel

  5. Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany

    Anika Nitzsche

  6. Institute for Medical Economics and Health Services Research, Rheinische Fachhochschule Cologne, Cologne, Germany

    Rainer Riedel

  7. Department of Neonatology and Pediatric Intensive Care and Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany

    Bernhard Roth

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  1. Felix Miedaner
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  2. Kristina Langhammer
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  3. Christian Enke
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Correspondence to Felix Miedaner.

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Miedaner, F., Langhammer, K., Enke, C. et al. Volume, size, professionals' specialization and nutrition management of NICUs and their association with treatment quality in VLBW infants. J Perinatol 38, 402–410 (2018). https://doi.org/10.1038/s41372-017-0036-0

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  • DOI: https://doi.org/10.1038/s41372-017-0036-0

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