Association of Low Hospital Birth Volume and Adverse Short-Term Outcomes for Neonates Treated with Therapeutic Hypothermia in Rural States

Objective: We hypothesized that outborn neonates from smaller birth volume hospitals would have more frequent adverse short-term outcomes following therapeutic hypothermia (TH). Study Design: Multicenter retrospective study comparing outcomes for small (<500 births/year), medium (501-1500 births/year), and large (>1500 births/year) hospitals in Northern New England. Multivariable logistic regression assessed the combined outcome of death/severe gray matter injury on MRI, controlling for encephalopathy severity and time to initiation of TH. Results: 531 neonates were included from small (N=120), medium (N=193), and large (N=218) volume hospitals and TH was initiated at a median of 4.5, 4, and 2 hours of life respectively. The odds of the combined outcome were 4.3-fold higher in small versus large birth volume hospitals (95% CI = 1.6, 12.1, p=0.004), but not different in medium birth volume hospitals. Conclusion: Neonates born in small volume hospitals had significantly higher odds of death or severe gray matter injury following TH.