A premature baby's outcome has more to do with the birth site than a pharmacologic supplement, according to new research from Baylor University Medical Center at Dallas. Because of those conclusions, which were recently published in the Journal of the American Medical Association Pediatrics, researchers expect a shift in the way neonatal care is delivered.
The findings come from a research study involving 6,200 premature infants born between 2010 and 2012 at U.S. hospitals. In looking at the data retrospectively, researchers set out to determine if the absence of a certain supplement affected the outcomes of those preemies.
That supplement was Vitamin A, a preventive therapy that was thought to reduce bronchopulmonary dysplasia, a chronic lung disease in extremely low birth weight babies. The supplement became popular from the early 2000s until 2010, when a national shortage stripped its availability from neonatal intensive care units (NICUs). This was substantial because, at the height of Vitamin A's popularity, about one in three NICUs across the country used it.
Results with a Surprising Twist
Baylor Research Institute's team, led by neonatal researcher Veeral Tolia, MD, along with biostatistician Monica Bennett, PhD, explored whether that shortage affected the babies. Among the 6,200 infants studied, some received Vitamin A during this time; others didn't. By looking at the data, researchers could investigate whether lack of Vitamin A impacted other babies born after 2010. What they found, in many ways, surprised them.
"When this medicine was taken away, there didn't appear to be an increase in bronchopulmonary dysplasia," said Dr. Tolia, a neonatal researcher at Baylor Dallas. "After having done the research, I'm pretty convinced that it doesn't really make a difference at all, actually."
A Shift from Pharmacy to Quality
But what did make a difference was the birth location. The results showed that a premature baby's place of birth had a direct link to his or her chance of death and chronic lung disease. This finding quashed the theory of Vitamin A, shifting it from a conversation about pharmacy to one of quality.
"If you're a premature baby, who your doctors are is probably more important than what medications they have available to treat you," Dr. Tolia said. "And that was surprising because nearly 20 years have passed since the Vitamin A trials were done, and in those 20 years, risk for bronchopulmonary dysplasia has decreased by about 10 to 15 percent."
This new research suggests that chronic lung disease has gone down because neonatal care has improved nationally, not because providers have been using Vitamin A.
"Independent of these drugs, I think we're getting better at caring for these infants in a non-pharmacologic way," Dr. Tolia said.
Answering the Quality Question
Of course, not all neonatal caregivers are equal, as evidenced by the findings. The study shows that outcomes vary by location, but what is it about those locations that impact the care babies get?
"That's the most important question we have to answer," Dr. Tolia said. "It may be the physician care, or it may be the nursing care. Or it may be a combination of things." He pointed to Baylor University Medical Center's NICU as an example. Baylor Dallas has had one of the nation's lowest mortality rates for premature babies for the past decade.
"Some people have suggested that the more volume of patients that you see, the better you become at taking care of them," he said. "This is probably a part of the story, but not all of it."
To finish telling that story, Dr. Tolia and his team will continue their research to identify what impacts the caliber of neonatal care. Many of those efforts will include a deeper look at the existing data to find similarities between the high-performing and low-performing centers.
"What is very exciting is that our research program at Baylor is addressing this question of quality at both national and local levels," he said. "We have presented Baylor Research's quality improvement work nationally, and we have three current projects focused extensively at how quality of care drives outcomes."
As those studies continue, the use of Vitamin A will likely dwindle as news of Baylor's research spreads. And while the shortage ended in September, its refreshed supply probably won't matter much to NICUs. That's good news for the babies born in 2014 and beyond: They escape the 12 injections that came with one Vitamin A dose.
