Admission volume is associated with mortality of neonatal respiratory failure in emerging neonatal intensive care units

Objective: The aim of this survey was to explore the relationship between admission volume and mortality of neonates with hypoxemic respiratory failure (NRF) in emerging neonatal intensive care units (NICUs). Methods: NRF from 55 NICUs were retrospectively included with death risk as the major outcome. Perinatal comorbidities, underlying disease severity, respiratory support, facility utilization, and economic burden in the early postnatal period were compared among five NICU admission volume categories defined by NRF incidence, with score for neonatal acute physiology perinatal extension II (SNAPPE-II) also assessed as initial severity. Results: Compared to NICUs with NRF < 50 cases/year, NRF incidence, NRF/NICU, NRF/NICU admissions, and magnitude of ventilator use were several times higher, and mortality rates 20-50% lower, in NICUs of 150-199 and >= 200 cases/year (p < .01), even after adjustment with SNAPPE-II in stratified ranges. Median SNAPPE-II values, which correlated with the death rate of NRF (r = .282, p < .001), were lower in NICUs of 150-199 and >= 200 than in <50, 50-99, and 100-149 categories (13 versus 18, p < .01). NRF mortalities were not correlated with the proportion of very low birth weight patients in each category. Conclusions: Neonates in NICUs with smaller NRF admission volume and decreased magnitude of ventilator use had a higher risk of death as assessed by SNAPPE-II, which should be targeted in the quality improvement of newly established, resource-limited NICUs.