# Between-center variability in the outcome of VLBW infants is not affected by socioeconomic deprivation

## TL;DR

The study found that outcomes for very low birth weight infants in Hungary improved over time, but differences between hospitals were not linked to socioeconomic factors.

## Contribution

This is the first population-based study of VLBW outcomes in Central-Eastern Europe, revealing no link between deprivation and NICU performance variability.

## Key findings

- The composite outcome (death or major morbidity) for VLBW infants decreased from 39.1% to 34.3% between 2014–2016 and 2019–2021.
- There was significant between-center variability in outcomes, but it was not correlated with socioeconomic deprivation.
- Mortality and late-onset sepsis rates decreased significantly over the study period.

## Abstract

While outcomes of very low birth weight (VLBW) infants have improved significantly in high-income countries over recent decades, data from Central-Eastern Europe are lacking. The study aimed to evaluate trends in VLBW infant outcomes and hypothesized that a variability exists in the performance of NICUs in Hungary.

This was a population-based cohort study of VLBW infants, conducted between 2014–2016 (Epoch 1); and between 2019–2021 (Epoch 2) involving all Level III NICUs in Hungary. The primary composite outcome was death or any of the five major morbidities. Adjustments were made for case-mix and hospital-level factors, and the impact of deprivation, a composite index of socioeconomic status, was assessed.

The composite outcome decreased from 39.1% in Epoch 1 (n = 3438) to 34.3% in Epoch 2 (n = 3084) (p < 0.001). Mortality rate reduced significantly by 1.7% (p = 0.028). The rate of late-onset sepsis dropped by 4.8% (p < 0.001). The adjusted odds of adverse composite outcome decreased 5% yearly (aOR 0.95 (95% C.I. 0.92–0.97)). There was a significant between-center variability in the composite outcome, but it showed no correlation with the deprivation.

Composite outcome trends improved over time, but substantial variability persists among NICUs which cannot be explained by patient characteristics, patient volume, or deprivation.

Our study presents the first comprehensive, population-based analysis of VLBW infant outcomes in the Central-Eastern European region.Composite outcome trends of death and the five major morbidities have shown significant improvement over the past decade among VLBW infants in Hungary.A substantial variability exists between the performance of level III NICUs, independent of case-mix and patient volume.The odds of adverse outcome in VLBW infants is not correlated with deprivation, a municipal level metric of socioeconomic status.

Our study presents the first comprehensive, population-based analysis of VLBW infant outcomes in the Central-Eastern European region.

Composite outcome trends of death and the five major morbidities have shown significant improvement over the past decade among VLBW infants in Hungary.

A substantial variability exists between the performance of level III NICUs, independent of case-mix and patient volume.

The odds of adverse outcome in VLBW infants is not correlated with deprivation, a municipal level metric of socioeconomic status.