TY - JOUR
T1 - Surfactant use for premature infants with respiratory distress syndrome in three New York city hospitals
T2 - Discordance of practice from a community clinician consensus standard
AU - Howell, E. A.
AU - Holzman, I.
AU - Kleinman, L. C.
AU - Wang, J.
AU - Chassin, M. R.
N1 - Funding Information:
Financial support for this work was provided by the Agency for Health, Agency for Healthcare Research and Quality (PO1 HS10859), the Commonwealth Fund (20030088), and the National Center for Minority Health and Health Disparities (P60 MD00270).
PY - 2010/9
Y1 - 2010/9
N2 - Objective:To assess concordance with a locally developed standard of care for premature infants with respiratory distress syndrome (RDS) for whom the standard recommends surfactant treatment within 2 h of birth, and to examine the association between clinical, demographic, and hospital characteristics with discordance from the standard.Study Design:Retrospective cohort study of 773 infants weighing 1750 g born in any of the three New York City hospitals between 1999 and 2002.Result:227 of the 773 infants (29%) met criteria for treatment according to the standard. Of these, 37% received surfactant by 2 h. By 4 h, 70% of infants who met the standard received surfactant. White infants were more likely to receive surfactant by 4 h (85%) than African American (61%) or Latino infants (67%). Multivariable logistic regression revealed significant odds ratios predicting discordance from the relaxed criteria (4 h) for African American race (4.10, 95% confidence interval: 1.30 to 13.00), 100 g of birth weight (odds ratio: 1.22, 95% confidence interval: 1.10 to 1.34), and hospital of birth.Conclusion:Many infants with RDS failed to receive surfactant replacement therapy at 2 and 4 h after birth. African Americans and those born larger were less likely to receive surfactant. If these data can be generalized, there is a large opportunity to reduce infant morbidity from RDS and to reduce racial/ethnic disparities in birth outcomes by increasing the rate and speed with which surfactant is delivered to these infants.
AB - Objective:To assess concordance with a locally developed standard of care for premature infants with respiratory distress syndrome (RDS) for whom the standard recommends surfactant treatment within 2 h of birth, and to examine the association between clinical, demographic, and hospital characteristics with discordance from the standard.Study Design:Retrospective cohort study of 773 infants weighing 1750 g born in any of the three New York City hospitals between 1999 and 2002.Result:227 of the 773 infants (29%) met criteria for treatment according to the standard. Of these, 37% received surfactant by 2 h. By 4 h, 70% of infants who met the standard received surfactant. White infants were more likely to receive surfactant by 4 h (85%) than African American (61%) or Latino infants (67%). Multivariable logistic regression revealed significant odds ratios predicting discordance from the relaxed criteria (4 h) for African American race (4.10, 95% confidence interval: 1.30 to 13.00), 100 g of birth weight (odds ratio: 1.22, 95% confidence interval: 1.10 to 1.34), and hospital of birth.Conclusion:Many infants with RDS failed to receive surfactant replacement therapy at 2 and 4 h after birth. African Americans and those born larger were less likely to receive surfactant. If these data can be generalized, there is a large opportunity to reduce infant morbidity from RDS and to reduce racial/ethnic disparities in birth outcomes by increasing the rate and speed with which surfactant is delivered to these infants.
UR - http://www.scopus.com/inward/record.url?scp=77956266216&partnerID=8YFLogxK
U2 - 10.1038/jp.2010.6
DO - 10.1038/jp.2010.6
M3 - Article
C2 - 20182436
AN - SCOPUS:77956266216
SN - 0743-8346
VL - 30
SP - 590
EP - 595
JO - Journal of Perinatology
JF - Journal of Perinatology
IS - 9
ER -