Kristie McNealy, MD

Researchers from the University of Michigan have recently published a study in the journal Pediatric Cardiology, showing once again, that the sickest babies do best at hospitals that see a high volume of similar patients. This study examined mortality for babies born with two complex heart defects - hypoplastic left heart syndrome and transposition of the great arteries - problems which both require complex surgery shortly after birth. They found that babies who were operated on in hospitals that did more of these procedures each year, had a lower risk of dying in the post operative period. Since all pediatric cardiac surgeons receive similar rigorous training, it is hypothesized that some of the difference in survival may be related to the experience level of other members of the surgical and post operative care team.

This study falls in line with a study published in the May 24, 2007 issue of the New England Journal of Medicine, showing that very low birth weight infants born at busier, higher level NICUs had a lower mortality rate than similar babies born at smaller, community based NICUs.

I think the take home message of these two studies, is that when a complex or very serious medical problem is involved, babies benefit from an effort to coordinate and transfer care to more experienced hospitals and caregivers. Differences in mortality should trump convenience unless parents have made a final decision not to pursue treatment, and to opt for palliative care.

References: J Hirsch, J Gurney, J Donohue, A Gebremariam, E Bove and R Ohye. Hospital Mortality for Norwood and Arterial Switch Operations as a Function of Institutional Volume. Ped Cardiology. Published online December 14, 2007.

C Phibbs, L Baker, A Caughey, B Danielsen, S Schmitt and R Phibbs. Level and Volume of Neonatal Intensive Care and Mortality in Very-Low-Birth-Weight Infants.  NEJM.  May 2007.  Volume 356:2165-2175.

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