{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T01:03:59Z","timestamp":1790039039956,"version":"4.0.1"},"reference-count":36,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,5,14]]},"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the effects of designation and volume of neonatal care at the hospital of birth on mortality and morbidity outcomes in very preterm infants in a managed clinical network setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective, population-based analysis of operational clinical data using adjusted logistic regression and instrumental variables (IV) analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>165 National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing and Clinical Outcomes Project.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>20\u2005554 infants born at &lt;33\u2005weeks completed gestation (17\u2005995 born at 27\u201332\u2005weeks; 2559 born at &lt;27\u2005weeks), admitted to neonatal care and either discharged or died, over the period 1 January 2009\u201331 December 2011.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Tertiary designation or high-volume neonatal care at the hospital of birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Neonatal mortality, any in-hospital mortality, surgery for necrotising enterocolitis, surgery for retinopathy of prematurity, bronchopulmonary dysplasia and postmenstrual age at discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Infants born at &lt;33\u2005weeks gestation and admitted to a high-volume neonatal unit at the hospital of birth were at reduced odds of neonatal mortality (IV regression odds ratio (OR) 0.70, 95% CI 0.53 to 0.92) and any in-hospital mortality (IV regression OR 0.68, 95% CI 0.54 to 0.85). The effect of volume on any in-hospital mortality was most acute among infants born at &lt;27\u2005weeks gestation (IV regression OR 0.51, 95% CI 0.33 to 0.79). A negative association between tertiary-level unit designation and mortality was also observed with adjusted logistic regression for infants born at &lt;27\u2005weeks gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High-volume neonatal care provided at the hospital of birth may protect against in-hospital mortality in very preterm infants. Future developments of neonatal services should promote delivery of very preterm infants at hospitals with high-volume neonatal units.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-004856","type":"journal-article","created":{"date-parts":[[2014,7,7]],"date-time":"2014-07-07T21:39:25Z","timestamp":1404769165000},"page":"e004856","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":67,"title":["The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study"],"prefix":"10.1136","volume":"4","author":[{"given":"S I","family":"Watson","sequence":"first","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Arulampalam","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Petrou","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Marlow","sequence":"additional","affiliation":[{"name":"Academic Neonatology, UCL Institute for Women's Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A S","family":"Morgan","sequence":"additional","affiliation":[{"name":"Academic Neonatology, UCL Institute for Women's Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E S","family":"Draper","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Santhakumaran","sequence":"additional","affiliation":[{"name":"Section of Neonatal Medicine, Department of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Modi","sequence":"additional","affiliation":[{"name":"Section of Neonatal Medicine, Department of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the Neonatal Data Analysis Unit and the NESCOP Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,7,7]]},"reference":[{"key":"2025121508575505000_4.7.e004856.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1226"},{"key":"2025121508575505000_4.7.e004856.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa065029"},{"key":"2025121508575505000_4.7.e004856.3","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.5.745"},{"key":"2025121508575505000_4.7.e004856.4","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181dbe887"},{"key":"2025121508575505000_4.7.e004856.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.2.202"},{"key":"2025121508575505000_4.7.e004856.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1624"},{"key":"2025121508575505000_4.7.e004856.7","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-2820"},{"key":"2025121508575505000_4.7.e004856.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.771"},{"key":"2025121508575505000_4.7.e004856.9","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.5.1230"},{"key":"2025121508575505000_4.7.e004856.10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-1964"},{"key":"2025121508575505000_4.7.e004856.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000218780.16064.df"},{"key":"2025121508575505000_4.7.e004856.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2423"},{"key":"2025121508575505000_4.7.e004856.13","unstructured":"Department of Health. 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