Abstract
To the Editor.— In their valuable report1 Dr Hack and colleagues confirm large variations between centers in the perinatal histories, treatment, and outcomes of very low birth weight infants. Unfortunately, in contrast to earlier reports,2,3 they neglect to mention the need for measures of initial disease severity. This is an important omission. In a survey of nine pediatric intensive care centers Pollack et al4 showed that hospital mortality varied from 3.6% to 17%. This large variation was explained completely by differences between hospital populations in initial severity of disease, calculated from routine indices of physiologic stability on the day of admission.
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