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Background <p>Very low birth weight infants (VLBWI) are at high risk of mortality and severe morbidities. While many neonatal networks monitor risk-adjusted outcomes separately, the relationship between mortality and major morbidities across centers remains unclear.</p> Objective <p>To evaluate the association between risk-adjusted in-hospital mortality and six major morbidities in VLBWI across 20 South American NICUs participating in the NEOCOSUR Network between 2011 and 2023.</p> Methods <p>Retrospective cohort study including 14,100 VLBWI (500–1500 g) from 20 NICUs in Argentina, Chile, Paraguay, Peru, and Uruguay. Observed-to-expected (O/E) ratios for mortality and for each morbidity—late-onset sepsis, bronchopulmonary dysplasia at 36 weeks (BPD), severe intraventricular hemorrhage (IVH grade III–IV), retinopathy of prematurity (ROP ≥ stage III), necrotizing enterocolitis (NEC ≥ stage II), and periventricular leukomalacia (PVL)—were calculated using logistic regression models adjusted for perinatal risk factors. Center-level associations were evaluated using Poisson regression models.</p> Results <p>O/E mortality varied widely across centers (range from 0.62 to 1.48), with 7 centers showing significantly lower-than-expected mortality and 4 with higher-than-expected values. Significant positive associations were found between mortality O/E and O/E of late-onset sepsis (χ² = 53.6, <i>p</i> &lt; 0.01), severe IVH (χ² = 18.0, <i>p</i> &lt; 0.01), ROP (χ² = 38.0, <i>p</i> &lt; 0.01), and PVL (χ² = 23.4, <i>p</i> &lt; 0.01). An inverse association was observed between mortality and BPD (χ² = 36.2, <i>p</i> &lt; 0.01). No significant association was found for NEC.</p> Conclusions <p>Centers with higher-than-expected mortality also showed excess rates of several severe morbidities, suggesting that shared care practices may be associated with multiple outcomes. The inverse association with BPD may reflect a survival bias. These findings support the integration of multiple adjusted outcomes in quality benchmarking across NICUs.</p>

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Association between risk-adjusted mortality and severe morbidity in very low birth weight infants: a multicenter study from the NEOCOSUR network

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Guillermo Marshall,
  • Jose Luis Tapia,
  • Angélica Dominguez,
  • Jorge Fabres,
  • Alvaro González,
  • Ivonne D’Apremont,
  • Gonzalo Mariani,
  • Cecilia Herbozo,
  • Fernando Silvera,
  • Catalina Vaz

摘要

Background

Very low birth weight infants (VLBWI) are at high risk of mortality and severe morbidities. While many neonatal networks monitor risk-adjusted outcomes separately, the relationship between mortality and major morbidities across centers remains unclear.

Objective

To evaluate the association between risk-adjusted in-hospital mortality and six major morbidities in VLBWI across 20 South American NICUs participating in the NEOCOSUR Network between 2011 and 2023.

Methods

Retrospective cohort study including 14,100 VLBWI (500–1500 g) from 20 NICUs in Argentina, Chile, Paraguay, Peru, and Uruguay. Observed-to-expected (O/E) ratios for mortality and for each morbidity—late-onset sepsis, bronchopulmonary dysplasia at 36 weeks (BPD), severe intraventricular hemorrhage (IVH grade III–IV), retinopathy of prematurity (ROP ≥ stage III), necrotizing enterocolitis (NEC ≥ stage II), and periventricular leukomalacia (PVL)—were calculated using logistic regression models adjusted for perinatal risk factors. Center-level associations were evaluated using Poisson regression models.

Results

O/E mortality varied widely across centers (range from 0.62 to 1.48), with 7 centers showing significantly lower-than-expected mortality and 4 with higher-than-expected values. Significant positive associations were found between mortality O/E and O/E of late-onset sepsis (χ² = 53.6, p < 0.01), severe IVH (χ² = 18.0, p < 0.01), ROP (χ² = 38.0, p < 0.01), and PVL (χ² = 23.4, p < 0.01). An inverse association was observed between mortality and BPD (χ² = 36.2, p < 0.01). No significant association was found for NEC.

Conclusions

Centers with higher-than-expected mortality also showed excess rates of several severe morbidities, suggesting that shared care practices may be associated with multiple outcomes. The inverse association with BPD may reflect a survival bias. These findings support the integration of multiple adjusted outcomes in quality benchmarking across NICUs.