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Association of low hospital birth volume and adverse short-term outcomes for neonates treated with therapeutic hypothermia in rural states

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

We hypothesized that outborn neonates in three rural states would have more frequent adverse short-term outcomes following therapeutic hypothermia (TH).

Study Design

Multicenter retrospective study comparing outcomes for low (<500 births/year), medium (501–1500 births/year), and high (>1500 births/year) birth volume hospitals in Northern New England. Multivariable logistic regression assessed the combined outcome of death/severe gray matter injury on MRI, controlling for encephalopathy severity and time to initiation of TH.

Results

Death occurred for 35/531 neonates: 15/120 (12%) low, 7/193 (4%) medium, and 13/218 (6%) for high birth volume hospitals (p = 0.008). Severe gray matter injury occurred in 8%, 6% and 7% of low, medium, and high birth volume hospitals, respectively (p = 0.7). Odds of the combined outcome were 4.3-fold higher in low versus high volume hospitals (95% CI = 1.6, 12.1, p = 0.004).

Conclusion

Neonates born in low volume birth hospitals had significantly higher odds of death following treatment with TH.

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Data availability

The datasets generated and analyzed for the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the individuals who contributed to data collection; Megan Berube, MD, Leah Fox, MD, Lauren McAllister, MD, and Sophi Aronson from MMC as well as Emily Fraser-Read. Delaney Davis, and Krysta Anderson from NLEMMC, Jessica Moya from Elliot Hospital, and Melanie Parziale, MD from The University of Vermont, Larner College of Medicine.

Funding

AKC, AC, and LMS were supported by grant 1P20GM139745-01 from the National Institutes of Health for the Center of Biomedical Research Excellence in Acute Care Research and Rural Disparities. AKC and the REDCap administrator were also supported by U54 GM115516 from the Northern New England Clinical and Translational Research network which funds the MaineHealth instance of REDCap.

Author information

Authors and Affiliations

  1. Division of Pediatric Neurology, Department of Pediatrics, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA

    Alexa K. Craig

  2. Associate Professor of Pediatrics, Tufts University School of Medicine, Boston, MA, USA

    Alexa K. Craig

  3. Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA

    Anya Cutler

  4. Division of Neonatology, Department of Pediatrics, Northern Light Eastern Maine Medical Center, Bangor, ME, USA

    Jay Kerecman

  5. Division of Neonatology, Department of Pediatrics, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA

    Misty Melendi & Allison Zanno

  6. Department of Pediatrics, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA

    Leah Marie Seften

  7. Division of Neonatology, Department of Pediatrics, Elliot Hospital, Manchester, NH, USA

    Matthew Ryzewski

  8. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA

    Deirdre O’Reilly

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  1. Alexa K. Craig
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Contributions

AKC contributions include study conceptualization and design, interpretation of findings, initial draft of the manuscript, and supervision and oversight of the research team. AC contributed to the study design, developed the analysis plan, and completed all analyses. JK, MR, MM, and AZ contributed to study design, data acquisition, and revising the manuscript. LMS contributed to data acquisition and revising the manuscript. DO’R contributed to study conceptualization and design, data acquisition, interpretation of findings, and revision of the manuscript. All authors approve the final version of this manuscript.

Corresponding author

Correspondence to Alexa K. Craig.

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The authors declare no competing interests.

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Craig, A.K., Cutler, A., Kerecman, J. et al. Association of low hospital birth volume and adverse short-term outcomes for neonates treated with therapeutic hypothermia in rural states. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02352-8

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  • DOI: https://doi.org/10.1038/s41372-025-02352-8

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