Maternal Characteristics and Rates of Unexpected Complications in Term Newborns by Hospital

• DOI: 10.1001/jamanetworkopen.2024.11699
• Publication Date: 2024-05-20T15:32:40Z
• Authors: Kimberly B. Glazer; Jennifer Zeitlin; Natalie Boychuk; Natalia N. Egorova; Paul L. Hebert; Teresa Janevic; Elizabeth A. Howell
• Keywords: Singleton

Importance The Joint Commission Unexpected Complications in Term Newborns measure characterizes newborn morbidity potentially associated with quality of labor and delivery care. Infant exclusions isolate relatively low-risk births, but unexpected complications (UNCs) are not adjusted for maternal factors that may be outcomes independently hospital quality. Objective To investigate the association between characteristics UNC rates. Design, Setting, Participants This cohort study was conducted using linked 2016 to 2018 New York City birth discharge datasets among 254 259 neonates at low risk (singleton, ≥37 weeks, birthweight ≥2500 g, without preexisting fetal conditions) 39 hospitals. Logistic regression used calculate unadjusted hospital-specific rates replicated analyses adjusting covariates. Hospitals were categorized into quintiles; changes quintile ranking adjustment examined. Data performed from December 2022 July 2023. Main Outcomes Measures UNCs classified according International Statistical Classification Diseases Related Health Problems, Tenth Revision ( ICD-10 ) criteria. Maternal preadmission comorbidities, obstetric factors, social characteristics, ascertained. Results Among singleton births 37 weeks or later who (125 245 female [49.3%] 129 014 male [50.7%]; 71 768 [28.2%] Hispanic, 47 226 [18.7%] non-Hispanic Asian, 42 682 [16.8%] Black, 89 845 [35.3%] White mothers 2738 [1.0%] another race ethnicity), 148 393 (58.4%) covered by Medicaid 101 633 (40.0%) commercial insurance. cumulative incidence hospitals 37.1 per 1000 births. Infants had increased risk; example, vs preeclampsia, there 104.4 35.8 respectively. hospitals, ranged 15.6 215.5 194.0 (median [IQR] change adjustment, 1.4 [−4.7 1.0] UNCs/1000 births). median (IQR) showed (<601 deliveries/year; −2.8 [−7.0 −1.6] UNCs) medium (601 <954 −3.9 [−7.1 −1.9] volume, public ownership (−3.6 [−6.2 −2.3] UNCs), high proportions Medicaid-insured (eg, ≥90.72%; −3.7 [−5.3 Black ≥32.83%; −5.3 [−9.1 −2.2] Hispanic ≥6.25%; patients significantly decreased after while did highest private ownership, predominantly privately insured individuals. all 7 (17.9%) shifted 1 comparing risk-adjusted rankings. Conclusions Relevance In this study, case mix small overall These performance assessment some these results suggest profiling on should consider implications higher-risk populations.