Risk-adjusted mortality of VLBW infants in high-volume versus low-volume NICUs.

Objective: To examine whether the number of very low birthweight (VLBW) infants treated annually in neonatal intensive care units (NICUs) (hospital volume) has an effect on their in-hospital mortality under the regulatory conditions in Germany.

Setting: The study included VLBW infants with <33 weeks of gestational age and birth weight below 1500 g admitted to NICUs in the state of Baden-Wüerttemberg, Germany, from 2003 to 2008. Cases were extracted from the compulsory German neonatal quality assurance programme with variables essential for calculation of the Clinical Risk Index for Babies (CRIB) and PREM birth model (PREM(bm)) scores.

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

Background: Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated.