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Hospital Rates of Active Tx Impact Survival in Very Preterm

For those born at 22, 23 weeks, variation in hospital rates of active tx explain most of survival difference

WEDNESDAY, May 6, 2015 (HealthDay News) -- For infants born at 22, 23, or 24 weeks of gestation, differences in hospital rates of active treatment explain some between-hospital differences in survival, according to a study published in the May 7 issue of the New England Journal of Medicine.

Matthew A. Rysavy, from the University of Iowa in Iowa City, and colleagues examined between-hospital variation in outcomes among extremely preterm infants. The authors assessed survival and neurodevelopmental impairment at 18 to 22 months of corrected age for 4,704 infants born before 27 weeks of gestation without congenital anomalies.

The researchers found that there was variation in overall rates of active treatment (from 22.1 to 99.8 percent among infants born at 22 and 26 weeks of gestation, respectively). There was variation in the overall rates of survival and survival without severe impairment (from 5.1 and 3.4 percent to 81.4 and 75.6 percent, respectively, for infants born at 22 and 26 weeks of gestation). Among children born at 22 or 23 weeks of gestation, hospital rates of active treatment accounted for 78 and 75 percent of the between-hospital variation in survival and survival without severe impairment, respectively, compared with 22 and 16 percent for those born at 24 weeks of gestation.

"Differences in practices regarding the initiation of active treatment in extremely preterm infants appear to explain a large portion of the between-hospital variation in survival among such patients," the authors write.

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