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Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia.

Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia.
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Murthy K, Porta NF, Lagatta JM, Zaniletti I, Truog WE, Grover TR, Nelin LD, Savani RC,


Murthy K, Porta NF, Lagatta JM, Zaniletti I, Truog WE, Grover TR, Nelin LD, Savani RC, (click to view)

Murthy K, Porta NF, Lagatta JM, Zaniletti I, Truog WE, Grover TR, Nelin LD, Savani RC,

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Journal of perinatology : official journal of the California Perinatal Association 2017 02 09() doi 10.1038/jp.2016.277
Abstract
OBJECTIVE
To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with severe bronchopulmonary dysplasia (sBPD)Study design:We analyzed the Children’s Hospitals Neonatal Database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sBPD. The association between center and the primary outcome of D/T was analyzed by multivariable modeling. Hypothesized diagnoses/practices were included to determine if these explained any observed ICV in D/T. RESULTS
D/T occurred in 280 (20%) of 1383 eligible infants from 21 centers. ICV was significant for D/T (range 2-46% by center, P<0.001) and tracheostomy placement (n=187, range 2-37%, P<0.001), but not death (n=93, range 0-19%, P=0.08). This association persisted in multivariable analysis (adjusted center-specific odds ratios for D/T varied 5.5-fold, P=0.009). CONCLUSIONS
ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.Journal of Perinatology advance online publication, 9 February 2017; doi:10.1038/jp.2016.277.

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