Variation in Survival Rates of Very Preterm Infants Across U.S. Health Systems: Implications for Sustainable Development Goals

Introduction

Nearly 10% of infants in the United States are born preterm, defined as birth before 37 weeks of gestation, according to the Centers for Disease Control and Prevention (CDC). Among these, infants with very low birthweights (under 3.3 pounds) are predominantly born very preterm (29 weeks gestation or earlier). Although they represent only 1% of births, these infants account for more than half of infant deaths annually in the U.S. A recent study by Penn State researchers highlights significant variations in mortality rates and hospital stays for very preterm infants across different health systems, emphasizing the need for quality improvement aligned with Sustainable Development Goal (SDG) 3: Good Health and Well-being.

Study Overview and Findings

1. Research Leadership and Publication: The study was led by Jeannette Rogowski, Professor of Health Policy and Administration at Penn State, and published in JAMA Network Open.
2. Population and Data Source: Analysis included 38,501 very preterm infants (24-29 weeks gestation) admitted to NICUs within the Vermont Oxford Network (VON), a global network dedicated to improving newborn care quality and safety.
3. Mortality Rate Variation: Overall mortality was 8.7%, with a two-percentage point difference between the highest (7.8%) and lowest (9.8%) performing health systems.
4. Length of Hospital Stay: Average stay was 81 days, ranging from 78 days in top-performing systems to 90 days in lower-performing ones.

Significance for Sustainable Development Goals

• SDG 3 – Good Health and Well-being: The study underscores the critical need to improve neonatal care quality to reduce infant mortality and morbidity, particularly among vulnerable populations such as very preterm infants.
• SDG 10 – Reduced Inequalities: Variations in outcomes across health systems highlight disparities in healthcare quality, calling for equitable access to high-standard neonatal intensive care units (NICUs).
• SDG 9 – Industry, Innovation, and Infrastructure: Enhancing NICU systems through data-driven quality improvement initiatives can foster innovation in healthcare delivery.
• SDG 17 – Partnerships for the Goals: The Vermont Oxford Network exemplifies global collaboration aimed at improving newborn health outcomes.

Policy Implications

• Medicaid finances nearly half of all U.S. births, including many very preterm infants, making quality improvement in NICUs a priority to optimize resource utilization and reduce healthcare costs.
• Reducing mortality by two percentage points and shortening hospital stays by up to 12 days could significantly impact healthcare expenditures and infant health trajectories.
• Addressing disparities in care quality aligns with national health equity goals and supports sustainable healthcare financing.

Future Directions

The study represents an initial step in identifying variation in NICU performance across health systems. Future research aims to:

• Identify drivers of variation such as staffing levels and resource distribution.
• Develop targeted interventions to enhance care quality and equity.
• Support health systems in adapting to ongoing changes to ensure optimal outcomes for vulnerable infants.

Conclusion

This research highlights the potential to improve survival rates and reduce hospital stays for very preterm infants through system-level quality improvements. These efforts contribute directly to achieving Sustainable Development Goals by promoting health equity, improving neonatal care, and fostering collaborative healthcare innovation.

Contributors

Additional authors include Lucy Greenberg (Vermont Oxford Network), Erika Edwards, Danielle Ehret, Jeffrey Buzas, and Jeffrey Horbar (University of Vermont).

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article focuses on infant mortality, preterm births, neonatal intensive care, and improving health outcomes for very preterm infants, which directly relate to ensuring healthy lives and promoting well-being at all ages.
2. SDG 10: Reduced Inequalities
   • The article discusses disparities in quality of care and outcomes across different health systems, implying a concern for reducing inequalities in healthcare access and quality.
3. SDG 17: Partnerships for the Goals
   • The involvement of networks such as the Vermont Oxford Network and collaborations among multiple hospitals and researchers highlights partnerships to improve healthcare quality and data sharing.

2. Specific Targets Under Those SDGs Identified

1. Under SDG 3: Good Health and Well-being
   • Target 3.2: End preventable deaths of newborns and children under 5 years of age, aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines.
2. Under SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, or other status.
3. Under SDG 17: Partnerships for the Goals
   • Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology, and financial resources.

3. Indicators Mentioned or Implied to Measure Progress

1. Neonatal Mortality Rate
   • The article provides specific mortality rates for very preterm infants (8.7% overall, with variation between 7.8% and 9.8% across health systems), which aligns with indicators measuring neonatal mortality under SDG 3.2.
2. Length of Hospital Stay
   • Length of stay in NICUs (average 81 days, ranging from 78 to 90 days) is used as an indicator of healthcare resource use and quality of care.
3. Quality of Care Variation Across Health Systems
   • Differences in mortality and length of stay across hospital systems imply indicators related to healthcare quality and equity, relevant to SDG 3.8 and SDG 10.2.
4. Enrollment in Quality Improvement Networks
   • Participation in the Vermont Oxford Network (covering nearly 90% of very low birth weight infants) serves as an indicator of collaborative efforts and partnerships under SDG 17.16.

4. Table of SDGs, Targets, and Indicators

Source: psu.edu