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Hospital variation in neonatal echocardiography among very preterm infants at US children’s hospitals

Journal of Perinatology volume 43, pages 181–186 (2023)Cite this article

Subjects

Abstract

Objective

Estimate hospital variation in echocardiography (echo) among very preterm infants.

Study design

Retrospective cohort study of very preterm (<32 weeks) infants discharged between 2012 and 2019 from US children’s hospitals. Echo exposure was identified using daily billing, and hospital variation was estimated after adjustment for illness severity. Variation in very early echo use (<3 days of life) was compared to exposure to treatment of a patent ductus arteriosus (PDA), and other practice patterns.

Results

27,498 subjects across 39 children’s hospitals were included. Very early echo use had the greatest hospital variation (3–34%). Increasing very early echo use was not associated with PDA treatment (p = 0.93), but was associated with nitric oxide (p < 0.01) and vasoactive medications (p < 0.01).

Conclusions

Hospital variation in echo use among preterm infants was greatest in the first few days of life and was associated with increasing nitric oxide and vasoactive medication use. The impact of this variation on clinical outcomes is uncertain and warrants further investigation.

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Fig. 1: Hospital variation in timing of initial echocardiography.
Fig. 2: Hospital variation in the average age of initial echocardiography.
Fig. 3: Association between the percentage of infants receiving a very early echo (<3 days of life) and echo-related costs per 100 patients at included children’s hospitals.
Fig. 4: Association between the percentage of infants receiving a very early echo (<3 days of life) and selected early treatment exposures.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

American Academy of Pediatrics—Marshall Klaus Perinatal Research Award.

Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Brian C. King

  2. Newborn Center, Texas Children’s Hospital, Houston, TX, USA

    Joseph Hagan

  3. Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson

  4. Complex Care, Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Jay Berry

  5. Center for Perinatal Research, Nationwide Children’s Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA

    Jonathan L. Slaughter

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  5. Jonathan L. Slaughter
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Contributions

All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work. Conceptualization/design/methodology: BCK, TR, JB, JS, JH. Investigation/formal analysis: BCK, TR, JB, JS, JH. Ppaer drafting: BCK, JS. Paper editing: BCK, TR, JB, JS, JH.

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Correspondence to Brian C. King.

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King, B.C., Hagan, J., Richardson, T. et al. Hospital variation in neonatal echocardiography among very preterm infants at US children’s hospitals. J Perinatol 43, 181–186 (2023). https://doi.org/10.1038/s41372-022-01522-2

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