• J H Chung, C S Phibbs, W J Boscardin, G F Kominski, A N Ortega, K D Gregory, and J Needleman.
• Department of Obstetrics and Gynecology, University of California, Orange, CA 92868, USA. judithc@uci.edu
• J Perinatol. 2011 Dec 1; 31 (12): 770-5.

ObjectiveThe objective of this study was to examine the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling.Study DesignThis is a secondary data analysis of California maternal-infant hospital discharge data from 1997 to 2002. The study population was limited to singleton, non-anomalous, very low birth weight infants, who delivered in hospitals providing neonatal intensive care services (level-2 and higher). Hierarchical generalized linear modeling, also known as multilevel modeling, was used to adjust for individual-level confounders.ResultIn a multilevel model, increasing hospital volume of very low birth weight deliveries was associated with lower odds of very low birth weight mortality. Characteristics of a particular hospital's obstetrical and neonatal services (the presence of residency and fellowship training programs and the availability of perinatal and neonatal services) had no independent effect.ConclusionUsing multilevel modeling, hospital volume of very low birth weight deliveries appears to be the primary driver of reduced mortality among very low birth weight infants.

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