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Measuring quality of care in moderate and late preterm infants



To examine quality measures for moderate and late preterm (MLP) infants.

Study design

By prospectively analyzing Vermont Oxford Network’s all NICU admissions database, we adapted Baby-MONITOR, a composite quality measure for extremely/very preterm infants, for MLP infants. We examined correlations between the adapted MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely and very preterm infants.


We studied 376,219 MLP (30–36 weeks GA) and 57,595 extremely/very preterm (25–29 weeks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM summary scores in MLP infants had weak correlation with Baby-MONITOR scores in extremely and very preterm infants (r = 0.47). There was weak correlation among survival (r = 0.19), no pneumothorax (r = 0.35), and no infection after 3 days (r = 0.45), but strong correlation among human milk at discharge (r = 0.79) and no hypothermia (r = 0.76).


Modest correlation among hospital care measures in two preterm populations suggests the need for MLP-specific care measures.

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Data availability

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  1. Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med. 2012;17:120–5.

    Article  Google Scholar 

  2. Teune MJ, Bakhuizen S, Bannerman CG, Opmeer BC, Van Kaam AH, Van Wassenaer AG, et al. A systematic review of severe morbidity in infants born late preterm. Am J Obstet Gynecol. 2011;205:374.e1–374.e9.

    Article  Google Scholar 

  3. Stewart DL, Barfield WD. Updates on an at-risk population: Late-preterm and early-term infants. Pediatrics. 2019;144:e20192760.

    Article  Google Scholar 

  4. Phibbs CS, Schmitt SK, Cooper M, Gould JB, Lee HC, Profit J, et al. Birth hospitalization costs and days of care for mothers and neonates in California, 2009–2011. J Pediatr. 2019;204:118–25.

    Article  Google Scholar 

  5. McCormick MC, Escobar GJ, Zheng Z, Richardson DK. Place of birth and variations in management of late preterm (“near-term”) infants. Semin Perinatol. 2006;30:44–7.

    Article  Google Scholar 

  6. Profit J, Gould JB, Zupancic J, Stark AR, Wall KM, Kowalkowski MA, et al. Formal selection of measures for a composite index of NICU quality of care: Baby-MONITOR. J Perinatol. 2011;31:702–10.

    Article  CAS  Google Scholar 

  7. Profit J, Kowalkowski MA, Zupancic JA, Pietz K, Richardson P, Draper D, et al. Baby-MONITOR: a composite indicator of NICU quality. Pediatrics. 2014;134:X8–X8.

    Article  Google Scholar 

  8. Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, et al. The Association of Level of Care with NICU Quality. Pediatrics. 2016;137:e20144210.

    Article  Google Scholar 

  9. Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, et al. Racial/ethnic disparity in NICU quality of care delivery. Pediatrics. 2017;140:e20170918.

    Article  Google Scholar 

  10. Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, et al. Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants. JAMA Pediatr. 2019;173:455–61.

    Article  Google Scholar 

  11. Edwards E, Greenberg L, Profit J, Draper D, Helkey D, Horbar J. Quality of Care in US NICUs by Race and Ethnicity. Pediatrics. 2021;148:e2020037622.

    Article  Google Scholar 

  12. Sebastião YV, Womack LS, Castillo HL, Balakrishnan M, Bruder K, Alitz P, et al. Hospital Variations in Unexpected Complications Among Term Newborns. Pediatrics. 2017;139:e20162364.

    Article  Google Scholar 

  13. Clapp MA, James KE, Bates SV, Kaimal AJ. Patient and hospital factors associated with unexpected newborn complications among term neonates in US hospitals. JAMA Netw Open. 2020;3:e19194–98.

    Article  Google Scholar 

  14. Horbar JD, Edwards EM, Greenberg LT, Morrow KA, Soll RF, Buus-Frank ME, et al. Variation in Performance of Neonatal Intensive Care Units in the United States. JAMA Pediatr. 2017;171:e164396.

    Article  Google Scholar 

  15. Vermont Oxford Network. Manual of operations: Part 1. Guidelines for database participation (Burlington; VT: Vermont Oxford Network; 2016).

  16. Jensen E, Dysart K, Gantz M, McDonald S, Bamat N, Keszler M, et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. an evidence-based approach. Am J Respir Crit Care Med. 2019;200:751–9.

    Article  CAS  Google Scholar 

  17. Patel AL, Engstrom JL, Meier PP, Kimura RE. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants. Pediatrics. 2005;116:1466–73.

    Article  Google Scholar 

  18. Simon L, Hanf M, Frondas-Chauty A, Darmaun D, Rouger V, Gascoin G, et al. Neonatal growth velocity of preterm infants: The weight Z-score change versus Patel exponential model. PLoS One. 2019;14:e0218746.

    Article  CAS  Google Scholar 

  19. Altman M, Vanpée M, Cnattingius S, Norman M. Moderately preterm infants and determinants of length of hospital stay. Arch Dis Child Fetal Neonatal Ed. 2009;94:414–8.

    Article  Google Scholar 

  20. Escobar GJ, McCormick MC, Zupancic JAF, Coleman-Phox K, Armstrong MA, Greene JD, et al. Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006;91:238–44.

    Article  Google Scholar 

  21. Profit J, McCormick MC, Escobar GJ, Richardson DK, Zheng Z, Coleman-Phox K, et al. Neonatal intensive care unit census influences discharge of moderately preterm infants. Pediatrics. 2007;119:314–9.

    Article  Google Scholar 

  22. Lee HC, Bennett MV, Schulman J, Gould JB, Profit J. Estimating length of stay by patient type in the neonatal intensive care unit. Am J Perinatol. 2016;33:751–7.

    Article  Google Scholar 

  23. Seaton SE, Barker L, Draper ES, Abrams KR, Modi N, Manktelow BN. Estimating neonatal length of stay for babies born very preterm. Arch Dis Child Fetal Neonatal Ed. 2019;104:F182–6.

    Article  Google Scholar 

  24. Bannwart DdeC, Rebello CM, Sadeck LS, Pontes MD, Ramos JL, Leone CR. Prediction of length of hospital stay in neonatal units for very low birth weight infants. J Perinatol. 1999;19:92–6.

    Article  Google Scholar 

  25. Cegolon L, Mastrangelo G, Campbell OM, Giangreco M, Alberico S, Montasta L, et al. Length of stay following cesarean sections: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-15. PLoS One. 2019;14:e0210753.

    Article  CAS  Google Scholar 

  26. Cegolon L, Campbell O, Alberico S, Montico M, Mastrangelo G, Monasta L, et al. Length of stay following vaginal deliveries: A population based study in the Friuli Venezia Giulia region (North-Eastern Italy), 2005-15. PLoS One. 2019;14:e0204919.

    Article  CAS  Google Scholar 

  27. Draper D, Gittoes M. Statistical analysis of performance indicators in UK higher education. J R Stat Soc. 2004;167:449–74.

    Article  Google Scholar 

  28. Britton J. Altitude, oxygen and the definition of bronchopulmonary dysplasia. J Perinatol. 2012;32:880–5.

    Article  CAS  Google Scholar 

  29. Helkey D. DD. dghrank: construct Draper-Gittoes-Helkey institution rankings. [Internet]. 2018. [accessed 12 Dec 2018].

  30. Dhurjati R, Sigurdson K, Profit J. Patient- and family-centered care as a dimension of quality. Am J Med Qual. 2019;34:307–8.

    Article  Google Scholar 

  31. Aberson C. Applied power analysis for the behavioral sciences. (New York, NY: Taylor & Francis Group LLC; 2010).

  32. Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: We need to ask more questions. Semin Perinatol. 2006;30:28–33.

    Article  Google Scholar 

  33. Profit J, Typpo KV, Hysong SJ, Woodard LCD, Kallen MA, Petersen LA. Improving benchmarking by using an explicit framework for the development of composite indicators: an example using pediatric quality of care. Implement Sci. 2010;5:1–10.

    Article  Google Scholar 

  34. Rosenthal G. Weak associations between hospital mortality rates for individual diagnoses: implications for profiling hospital quality. Am J Public Health. 1997;87:429–33.

    Article  CAS  Google Scholar 

  35. National Quality Forum. Endorsement Summary: Cardiovascular Measures [Internet]. 2012 [accessed 9 Dec 2021].

  36. National Quality Forum. Endorsement summary: pulmonary and critical care measures [Internet]. 2012 [accessed 9 Dec 2021].

  37. National Quality Forum. Endorsement Summary: Neurology Measures [Internet]. 2013 [accessed 9 Dec 2021].

  38. National Quality Forum. Perinatal and Women’s Health, Spring 2020 Cycle, CDP Report. 2021.

  39. Silber JH, Rosenbaum PR, Ross RN, Ludwig JM, Wang W, Niknam BA, et al. A hospital-specific template for benchmarking its cost and quality. Heal Serv Res. 2014;49:1475–97.

    Article  Google Scholar 

  40. Silber J, Rosenbaum P, Ross R, Ludwig J, Wang W, Niknam B, et al. Indirect standardization matching: assessing specific advantage and risk synergy. Health Serv Res. 2016;51:2330–57.

    Article  Google Scholar 

  41. Schulman J, Braun D, Lee HC, Profit J, Duenas G, Bennett MV, et al. Association between neonatal intensive care unit admission rates and illness acuity. JAMA Pediatr. 2018;172:17–23.

    Article  Google Scholar 

  42. Edwards EMHJ. Variation in use by NICU types in the United States. Pediatrics 2018;142:e20180457.

    Article  Google Scholar 

  43. Smazal A, Kavars A, Carlson S, Tolaizy T, Dagle J. Peripherally inserted central catheters optimize nutrient intake in moderately preterm infants. Pediatr Res. 2016;80:185–9.

    Article  CAS  Google Scholar 

  44. Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: trends, predictors and outcomes. J Neonatal Perinat Med. 2014;7:29–38.

    Article  Google Scholar 

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We are indebted to our colleagues who submit data to VON on behalf of infants and their families. The list of centers contributing data to this study is in Supplementary Table 4.

Author information

Authors and Affiliations



Elizabeth G Salazar conceptualized and designed the study, drafted the initial manuscript, reviewed and revised the manuscript. Sara C Handley conceptualized and designed the study, critically reviewed and revised the manuscript. Lucy T Greenberg carried out the analyses, critically reviewed and revised the manuscript. Scott A Lorch conceptualized and designed the study, critically reviewed and revised the manuscript. Erika M Edwards conceptualized and designed the study, carried out and oversaw the analyses, critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Elizabeth G. Salazar.

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Competing interests

Erika M Edwards receives salary support from Vermont Oxford Network. Lucy T Greenberg is an employee of Vermont Oxford Network. T32HL098054 (to EGS). There are no additional conflicts of interest to disclose.

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Salazar, E.G., Handley, S.C., Greenberg, L.T. et al. Measuring quality of care in moderate and late preterm infants. J Perinatol 42, 1294–1300 (2022).

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