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Lim J, Yoon SJ, Shin JE, Han JH, Lee SM, Eun HS, Park MS, Park KI. Growth Pattern With Morbidities From Birth to 5 Years of Age in Very Low Birth Weight Infants: Comparison of the Korean National Network and National Health Insurance Service. J Korean Med Sci 2022; 37:e162. [PMID: 35607740 PMCID: PMC9127431 DOI: 10.3346/jkms.2022.37.e162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Long-term growth data of very low birth weight (VLBW) infants are currently collected in the Korean Neonatal Network (KNN) and National Health Insurance Service (NHIS) database. However, variance in the number of infants, check-up time, and check-up parameters led to decreased credibility of cumulated data. We aimed to compare the data on serial growth outcomes by major morbidities from birth to 5 years in VLBW infants between the KNN and NHIS databases. METHODS We combined the NHIS and KNN data of VLBW infants born between 2013 and 2015. The check-up times in the NHIS database were at 4-6, 9-12, 18-24, 30-36, 42-48, and 54-60 months of age, whereas in the KNN were at 18-24 months of corrected age and at 36 months of age. RESULT Among 8,864 VLBW infants enrolled based on the birth certificates from the Statistics Korea, 6,086 infants (69%) were enrolled in the KNN, and 5,086 infants (57%) participated in the NHIS health check-up. Among 6,068 infants, 3,428 infants (56%) were enrolled at a corrected age of 18-24 months and 2,572 infants (42%) were enrolled at a chronological age of 33-36 months according to the KNN follow-up registry. However, based on the national birth statistics data, the overall follow-up rate of the KNN at 36 months of age was as low as 29%. The NHIS screening rate was lower at first (23%); however, it increased over time to exceed the KNN follow-up rate. Growth failure (weight under 10th percentile) at corrected ages of 18-24 months and 36 months were more common in the NHIS than KNN (42% vs. 20%, 37% vs. 34.5%). Infants with bronchopulmonary dysplasia and periventricular leukomalacia showed similar rates of growth failure at 2 years but varying rates at 3 years between the KNN and NHIS. CONCLUSION By integrating the KNN and NHIS data indirectly at continuous time points according to morbidities, we found that there are discontinuities and discrepancies between the two databases among VLBW infants. Establishing an integrated system by patient level linking the KNN and NHIS databases can lead to better understanding and improved neonatal outcomes in VLBW infants in Korea.
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Affiliation(s)
- Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Kato S, Ito M, Saito M, Miyahara N, Namba F, Ota E, Nakanishi H. Severe bronchopulmonary dysplasia in extremely premature infants: a scoping review protocol for identifying risk factors. BMJ Open 2022; 12:e062192. [PMID: 35545385 PMCID: PMC9096528 DOI: 10.1136/bmjopen-2022-062192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The remarkable improvement in the long-term prognosis of extremely premature infants has led to an increase in the number of cases of bronchopulmonary dysplasia (BPD). BPD affects pulmonary function and developmental outcomes, resulting in high chronic health burdens for infants and their families over the years. Therefore, identifying its risk factors in the early period of life and exploring better prophylactics and treatment strategies are important.The objectives of our scoping review are to screen available evidence, identify perinatal risk factors involved in the development and severity of BPD and devise a novel disease classification system that can predict long-term prognosis. METHODS AND ANALYSIS Eligibility criteria are as follows: articles published from 2002 to 2021; studies conducted in developed countries; articles written in English (PubMed) or Japanese (Ichushi); randomised controlled trials, prospective/retrospective cohort studies or case-control studies; extremely premature infants born before 28 weeks of gestational age; and articles in which endpoint was severe BPD as classified by the National Institute of Child Health and Human Development.We will screen the titles and abstracts of studies identified by independent reviewers using the population-concept-context framework. After a full-text review and data charting, we will provide the perinatal risk factors for severe BPD along with the risk ratio or odds ratio, 95% confidence interval and p values. ETHICS AND DISSEMINATION Institutional review board approval is not required due to the nature of the study. The results of this review will be disseminated through peer-reviewed publications and presentations at relevant conferences.Protocol V.1, 22 September 2021 TRIAL REGISTRATION NUMBER: UMIN000045529.
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Affiliation(s)
- Shin Kato
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masato Ito
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Makoto Saito
- Department of Child Health, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Naoyuki Miyahara
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Erika Ota
- Graduate School of Nursing Sciences, Global Health Nursing, St Luke's International University, Chuo-ku, Tokyo, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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53
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Isayama T, Kusuda S, Adams M, Berti E, Battin M, Helenius K, Håkansson S, Vento M, Norman M, Reichman B, Noguchi A, Lee SK, Bassler D, Lui K, Lehtonen L, Yang J, Shah PS. International Variation in the Management of Patent Ductus Arteriosus and Its Association with Infant Outcomes: A Survey and Linked Cohort Study. J Pediatr 2022; 244:24-29.e7. [PMID: 34995641 DOI: 10.1016/j.jpeds.2021.12.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether treating patients with a presymptomatic patent ductus arteriosus (PDA), based on early routine echocardiography, performed regardless of clinical signs, improved outcomes. STUDY DESIGN This multicenter, survey-linked retrospective cohort study used an institutional-level questionnaire and individual patient-level data and included infants of <29 weeks of gestation born in 2014-2016 and admitted to tertiary neonatal intensive care units (NICUs) of 9 population-based national or regional neonatal networks. Infants in NICUs receiving treatment of presymptomatic PDA identified by routine echocardiography and those not were compared for the primary composite outcome (early death [≤7 days after birth] or severe intraventricular hemorrhage) and secondary outcomes (any in-hospital mortality and major morbidities). RESULTS The unit survey (response rates of 86%) revealed a wide variation among networks in the treatment of presymptomatic PDA (7%-86%). Among 246 NICUs with 17 936 infants (mean gestational age of 26 weeks), 126 NICUs (51%) with 7785 infants treated presymptomatic PDA. The primary outcome of early death or severe intraventricular hemorrhage was not significantly different between the NICUs treating presymptomatic PDA and those who did not (17% vs 21%; aOR 1.00, 95% CI 0.85-1.18). The NICUs treating presymptomatic PDA had greater odds of retinopathy of prematurity treatment (13% vs 7%; aOR 1.47, 95% CI 1.01-2.12); however, it was not significant in a sensitivity analysis excluding Japanese data. CONCLUSIONS Treating presymptomatic PDA detected by routine echocardiography was commonplace but associated with no significant benefits. Well-designed trials are needed to assess the efficacy and safety of early targeted PDA treatment.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Elettra Berti
- Neonatal Intensive Care Unit, Medical Surgical Fetal-Neonatal Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Malcolm Battin
- Department of Neonatology, Auckland District Health Board, Auckland, New Zealand
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Maximo Vento
- Division of Neonatology, Health Research Institute La Fe, Valencia, Spain
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Akihiko Noguchi
- Illinois Neonatal Network, Saint Louis University, Saint Louis, IL
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Chevallier M, Debillon T, Darlow BA, Synnes AR, Pierrat V, Hurrion E, Yang J, Ego A, Ancel PY, Lui K, Shah PS, Luu TM. Mortality and significant neurosensory impairment in preterm infants: an international comparison. Arch Dis Child Fetal Neonatal Ed 2022; 107:317-323. [PMID: 34509987 DOI: 10.1136/archdischild-2021-322288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/25/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare mortality and rates of significant neurosensory impairment (sNSI) at 18-36 months' corrected age in infants born extremely preterm across three international cohorts. DESIGN Retrospective analysis of prospectively collected neonatal and follow-up data. SETTING Three population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2). PATIENTS Extremely preterm neonates of <28 weeks' gestation in year 2011. MAIN OUTCOME MEASURES Primary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness. RESULTS Overall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants' baseline characteristics). CONCLUSIONS Composite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.
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Affiliation(s)
- Marie Chevallier
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France .,TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
| | - Thierry Debillon
- Neonatal Intensive Care Unit, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France.,TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
| | - Brian A Darlow
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Anne R Synnes
- Department of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Véronique Pierrat
- Obstetrical Perinanal And Pediatric Epidemiology Research team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, Île-de-France, France.,Departement of Neonatal medicine, Lille University Hospital, Lille, France
| | - Elizabeth Hurrion
- Department of Newborn Services, Mater Mothers Hospital and Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Junmin Yang
- Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anne Ego
- TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France.,CIC U1406, INSERM, Grenoble, France.,Department of Public Health, Grenoble Alps University Hospital, Grenoble, France
| | - Pierre Yves Ancel
- Obstetrical Perinanal And Pediatric Epidemiology Research team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, Île-de-France, France.,Clinical Investigation center P1419, Paris Public Assistance Hospital, Paris, France
| | - Kei Lui
- Department of Newborn Care, Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Sydney, New South Wales, Australia
| | - Prakeshkumar S Shah
- Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Thuy Mai Luu
- Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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Variane GFT, Camargo JPV, Rodrigues DP, Magalhães M, Mimica MJ. Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care. Front Pediatr 2022; 9:755144. [PMID: 35402367 PMCID: PMC8984110 DOI: 10.3389/fped.2021.755144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.
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Affiliation(s)
- Gabriel Fernando Todeschi Variane
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Division of Neonatology, Grupo Santa Joana, São Paulo, Brazil
| | - João Paulo Vasques Camargo
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Data Science Department, OPD Team, São Paulo, Brazil
| | - Daniela Pereira Rodrigues
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Pediatric Nursing Department, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maurício Magalhães
- Division of Neonatology, Department of Pediatrics, Irmandade de Misericordia da Santa Casa de São Paulo, São Paulo, Brazil
- Clinical Research Department, Protecting Brains and Saving Futures Organization, São Paulo, Brazil
- Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Jenné Mimica
- Department of Pathology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Department of Pediatrics, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
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Impact of patient positions in lung ultrasound protocol: author's reply. J Perinatol 2022; 42:290. [PMID: 34845296 DOI: 10.1038/s41372-021-01281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022]
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Frühgeborenennachsorge in Österreich: Etablierung eines nationalen Registers. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-021-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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58
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Kawai Y, Hayakawa M, Tanaka T, Yamada Y, Nakayama A, Kato Y, Kouwaki M, Kato T, Tanaka R, Muramatsu K, Hayashi S, Yamamoto H, Takemoto K, Ieda K, Nagaya Y, Honda S, Shinohara O, Funato Y, Kokubo M, Imamine H, Miyata M. Pulmonary hypertension with bronchopulmonary dysplasia: Aichi cohort study. Pediatr Int 2022; 64:e15271. [PMID: 35972055 DOI: 10.1111/ped.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of pulmonary hypertension (PH) associated with bronchopulmonary dysplasia (BPD) has not been investigated in regional cohorts. The aim of this study was to clarify the incidence of PH associated with BPD in all very low birthweight infants (VLBWIs) born during the study period in Aichi Prefecture, Japan. METHODS We conducted a retrospective observational cohort study of all VLBWIs born in Aichi Prefecture. The inclusion criteria were VLB, birth between 1 January 2015 and 31 December 2015, and admission to any neonatal intensive care unit in Aichi Prefecture. BPD28d and BPD36w were defined as the need for supplemental oxygen or any respiratory support at 28 days of age or 36 weeks of postmenstrual age (PMA). The primary outcome was the incidence of PH after 36 weeks' PMA (PH36w) in VLBWIs with BPD28d and BPD36w. The secondary outcomes were the clinical factors related to PH36w in BPD36w patients. Mann-Whitney U-test and Fisher's exact test were used for univariate analysis. Differences were considered statistically significant at P < 0.05. Risk ratio (RR) and 95% confidence interval (CI) were also evaluated. RESULTS A total of 441 patients were analyzed. A total of 217 and 131 patients met the definition of BPD28d and BPD36w, respectively. Nine patients were diagnosed with PH36w (4.2% and 6.9% of the BPD28d and BPD36w patients, respectively). The presence of oligohydramnios (RR, 2.71; 95% CI: 1.55-4.73, P = 0.014) and sepsis (RR, 3.62; 95% CI: 1.51-8.63, P = 0.025) was significant in the PH36w patients. CONCLUSIONS The incidence of PH36w was 4.2% and 6.9% in the BPD28d and BPD36w patients, respectively. Oligohydramnios and sepsis were significantly associated with PH36w in VLBWIs.
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Affiliation(s)
- Yuri Kawai
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Taihei Tanaka
- Department of Pediatrics, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Yasumasa Yamada
- Department of Perinatal and Neonatal Medicine, Aichi Medical University, Nagakute, Japan
| | - Atsushi Nakayama
- Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuichi Kato
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan
| | - Masanori Kouwaki
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takenori Kato
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan.,Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Tanaka
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.,Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Kanji Muramatsu
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan.,Department of Pediatrics, Nagoya City West Medical Center, Nagoya, Japan
| | - Seiji Hayashi
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Hikaru Yamamoto
- Department of Pediatrics, Toyota Memorial Hospital, Toyota, Japan
| | - Koji Takemoto
- Department of Pediatrics, Konan Kosei Hospital, Konan, Japan
| | - Kuniko Ieda
- Department of Pediatrics, Tosei General Hospital, Seto, Japan
| | - Yoshiaki Nagaya
- Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Shigeru Honda
- Department of Pediatrics, Komaki City Hospital, Komaki, Japan
| | | | - Yusuke Funato
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.,Department of Pediatrics, Kariya Toyota General Hospital, Kariya, Japan
| | - Minoru Kokubo
- Department of Pediatrics, Kainan Hospital, Yatomi, Japan
| | - Hiroki Imamine
- Department of Pediatrics, Holy Spirit Hospital, Nagoya, Japan
| | - Masafumi Miyata
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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Development of a small baby unit to improve outcomes for the extremely premature infant. J Perinatol 2022; 42:157-164. [PMID: 33712714 PMCID: PMC7952830 DOI: 10.1038/s41372-021-00984-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/17/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
Survival and outcomes for extremely premature (EP) infants have improved and even infants born at 23 and 24 weeks that were previously considered non-viable are now routinely surviving. This review describes our particular institution's basis for and process of creating and sustaining a small baby program for a quaternary, referral-based neonatal intensive care unit. Through multi-disciplinary collaboration, small baby guidelines were developed that established uniform care and optimized evidence-based practice for the care of this unique patient population. A focus on parent-centered care while removing noxious stimuli for the patient has improved neurodevelopmental outcomes. Data collection, quality improvement, and ongoing research are incorporated in the small baby program to establish and sustain best practices and outcomes for the EP patient. Through the establishment of a small baby unit, we have improved survival, decreased short-term morbidities, and improved neurodevelopmental outcomes for the EP infant in our region.
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Respiratory morbidity in preterm infants predicted by natriuretic peptide (MR-proANP) and endothelin-1 (CT-proET-1). Pediatr Res 2022; 91:1478-1484. [PMID: 33958715 PMCID: PMC8100356 DOI: 10.1038/s41390-021-01493-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a major complication in preterm infants <32 weeks. We aimed to assess whether plasma levels of mid-regional pro-atrial natriuretic peptide (MR-proANP) and C-terminal pro-endothelin-1 (CT-proET-1) predict respiratory morbidity. METHODS This was a prospective, two-center, observational cohort study. MR-proANP and CT-proET-1 were measured at day 7 (±2) of life. Associations with duration of supplemental oxygen and the composite outcome of moderate or severe BPD or death (BPD/death) were investigated. RESULTS Two hundred and twenty-nine infants <32 weeks were included (median gestational age [GA] 29.6 weeks [interquartile range 29.0-30.7], median birth weight 1150 g [IQR 840-1410]). MR-proANP and CT-proET-1 were associated with the duration of supplemental oxygen in univariable analysis (both p < 0.001) but not after adjusting for co-factors. Infants with BPD/death showed higher plasma levels of MR-proANP (623.50 pmol/L [IQR 458.50-881.38] vs. 308.35 pmol/L [IQR 216.72-538.10]; p < 0.001) and CT-proET-1 (255.40 pmol/L [IQR 202.60-311.15] vs. 198.30 pmol/L [IQR 154.70-297.95]; p = 0.015) compared to infants without BPD/death. Levels of both biomarkers were significantly associated with BPD/death in univariable models but not after adjusting for co-factors. CONCLUSIONS MR-proANP and CT-proET-1 are associated with the duration of supplemental oxygen and the composite outcome BPD/death, but their prognostic value does not complement that of clinical risk factors. IMPACT Plasma levels of MR-proANP and CT-proET-1, measured on day 7 of life (±2 days) are associated in univariable analyses with duration of supplemental oxygen and the combined outcome of BPD or death in VLGA infants. Associations between both biomarkers and respiratory morbidity do not persist in multivariable models, in particular when gestational age is included. MR-proANP and CT-proET-1 have limited additional value to predict respiratory morbidity in VLGA infants compared to clinical parameters.
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Rizzolo A, Shah PS, Bertelle V, Makary H, Ye XY, Abenhaim HA, Piedboeuf B, Beltempo M. Association of timing of birth with mortality among preterm infants born in Canada. J Perinatol 2021; 41:2597-2606. [PMID: 34050244 DOI: 10.1038/s41372-021-01092-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the association between time of birth and mortality among preterm infants. STUDY DESIGN Population-based study of infants born 22-36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. RESULT Among infants 22-27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01-1.29). Among infants 28-32 weeks GA and 33-36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59-0.95; AOR 0.78, 95% CI 0.62-0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28-32 and 33-36 weeks GA decreased or were not statistically significant. CONCLUSION Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.
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Affiliation(s)
- Angelo Rizzolo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Prakesh S Shah
- Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Valerie Bertelle
- Department of Pediatrics, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Hala Makary
- Department of Pediatrics, Dr. Everett Chalmers Hospital, Fredericton, NB, Canada
| | - Xiang Y Ye
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Université Laval, Quebec, QC, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Cesarean section was not associated with mortality or morbidities advantage in very low birth weight infants: a nationwide cohort study. Sci Rep 2021; 11:20264. [PMID: 34642372 PMCID: PMC8511270 DOI: 10.1038/s41598-021-99563-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
This study investigated the role of cesarean section (CS) in mortality and morbidity of very-low-birth-weight infants (VLBWIs) weighing less than 1500 g. This nationwide prospective cohort study of the Korean Neonatal Network consisted of 9,286 VLBWIs at 23–34 gestational weeks (GW) of age between 2013 and 2017. The VLBWIs were stratified into 23–24, 25–26, 27–28 and 29–34 GW, and the mortality and morbidity were compared according to the mode of delivery. The total CS rate was 78%, and was directly proportional to gestational age. The CS rate was the lowest at 61% in case of infants born at 23–24 GW and the highest at 84% in VLBWIs delivered at 29–34 GW. Contrary to the significantly lower total mortality (12%) and morbidities including sepsis (21%) associated with CS than vaginal delivery (VD) (16% and 24%, respectively), the mortality in the 25–26 GW (26%) and sepsis in the 27–28 GW (25%) and 29–34 GW (12%) groups were significantly higher in CS than in VD (21%, 20% and 8%, respectively). In multivariate analyses, the adjusted odds ratios (ORs) for mortality (OR 1.06, 95% CI 0.89–1.25) and morbidity including sepsis (OR 1.12, 95% CI 0.98–1.27) were not significantly reduced with CS compared with VD. The adjusted ORs for respiratory distress syndrome (1.89, 95% CI 1.59–2.23) and symptomatic patent ductus arteriosus (1.21, 95% CI 1.08–1.37) were significantly increased with CS than VD. In summary, CS was not associated with any survival or morbidity advantage in VLBWIs. These findings indicate that routine CS in VLBWIs without obstetric indications is contraindicated.
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吴 新, 谷 传, 韩 树, 邓 晓, 陈 筱, 王 淮, 李 双, 王 军, 周 勤, 侯 玮, 高 艳, 韩 良, 刘 红, 余 章, 王 增, 李 娜, 李 海, 周 金, 陈 珊, 姜 善, 路 星, 潘 兆, 陈 小. A multicenter retrospective study on survival rate and complications of very preterm infants. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:814-820. [PMID: 34511171 PMCID: PMC8428915 DOI: 10.7499/j.issn.1008-8830.2102037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the survival rate and the incidence of complications of very preterm infants and the factors influencing the survival rate and the incidence of complications. METHODS The medical data of the very preterm infants with a gestational age of <32 weeks and who were admitted to the Department of Neonatology in 11 hospitals of Jiangsu Province in China from January 2018 to December 2019 were retrospectively reviewed. Their survival rate and the incidence of serious complications were analyzed. A multivariate logistic regression analysis was used to evaluate the risk factors for death and serious complications in very preterm infants. RESULTS A total of 2 339 very preterm infants were enrolled, among whom 2 010 (85.93%) survived and 1 507 (64.43%) survived without serious complications. The groups with a gestational age of 22-25+6 weeks, 26-26+6 weeks, 27-27+6 weeks, 28-28+6 weeks, 29-29+6 weeks, 30-30+6 weeks, and 31-31+6 weeks had a survival rate of 32.5%, 60.6%, 68.0%, 82.9%, 90.1%, 92.3%, and 94.8% respectively. The survival rate tended to increase with the gestational age (P<0.05) and the survival rate without serious complications in each gestational age group was 7.5%, 18.1%, 34.5%, 52.2%, 66.7%, 75.7%, and 81.8% respectively, suggesting that the survival rate without serious complications increased with the gestational age (P<0.05). The multivariate logistic regression analysis showed that high gestational age, high birth weight, and prenatal use of glucocorticoids were protective factors against death in very preterm infants (P<0.05), and 1-minute Apgar score ≤3 was a risk factor for death in very preterm infants (P<0.05); high gestational age and high birth weight were protective factors against serious complications in very preterm infants who survived (P<0.05), while 5-minute Apgar score ≤3 and maternal chorioamnionitis were risk factors for serious complications in very preterm infants who survived (P<0.05). CONCLUSIONS The survival rate is closely associated with gestational age in very preterm infants. A low 1-minute Apgar score (≤3) may increase the risk of death in very preterm infants, while high gestational age, high birth weight, and prenatal use of glucocorticoids are associated with the reduced risk of death. A low 5-minute Apgar score (≤3) and maternal chorioamnionitis may increase the risk of serious complications in these infants, while high gestational age and high birth weight may reduce the risk of serious complications.
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Affiliation(s)
| | - 传丽 谷
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| | - 树萍 韩
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| | | | | | | | | | - 军 王
- 徐州医科大学附属医院新生儿科,江苏徐州221002
| | | | | | - 艳 高
- 连云港市妇幼保健院新生儿科,江苏连云港222000
| | | | | | - 章斌 余
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
| | | | | | | | | | - 珊珊 陈
- 徐州医科大学附属医院新生儿科,江苏徐州221002
| | | | | | | | - 小慧 陈
- 南京医科大学附属妇产医院新生儿科,江苏南京210004
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Shaik NB, Bandiya P, Nanda D, Pullattayil S. AK, Murki S, Roehr CC. ELBW and ELGAN outcomes in developing nations-Systematic review and meta-analysis. PLoS One 2021; 16:e0255352. [PMID: 34352883 PMCID: PMC8342042 DOI: 10.1371/journal.pone.0255352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Context Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied. Objectives Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs. Data sources CENTRAL, EMBASE, MEDLINE and Web of Science. Study selection Prospective and retrospective observational studies were included. Data extraction and synthesis Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE). Results 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE–low) for ELBW and 39% (34% - 44%) (CoE—moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000–2009 and 2010–2020. Except for necrotising enterocolitis [ELBW and ELGANs—8% (7% - 10%)] and periventricular leukomalacia [ELBW—7% (4% - 11%); ELGANs—6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs. Limitations CoE was very low to low for all secondary outcomes. Conclusions Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies. Trial registration PROSPERO (CRD42020222873).
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
- * E-mail:
| | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | - Prathik Bandiya
- Department of Neonatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Debasish Nanda
- Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India
| | | | - Srinivas Murki
- Department of Neonatology, Paramitha Women and Children’s Hospital, Hyderabad, India
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, United Kingdom
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom
- University of Bristol, Women’s and Children Division, Bristol, United Kingdom
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Cao Y, Jiang S, Sun J, Hei M, Wang L, Zhang H, Ma X, Wu H, Li X, Sun H, Zhou W, Shi Y, Wang Y, Gu X, Yang T, Lu Y, Du L, Chen C, Lee SK, Zhou W. Assessment of Neonatal Intensive Care Unit Practices, Morbidity, and Mortality Among Very Preterm Infants in China. JAMA Netw Open 2021; 4:e2118904. [PMID: 34338792 PMCID: PMC8329742 DOI: 10.1001/jamanetworkopen.2021.18904] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Chinese Neonatal Network was established in 2018 and maintains a standardized national clinical database of very preterm or very low-birth-weight infants in tertiary neonatal intensive care units (NICUs) throughout China. National-level data on outcomes and care practices of very preterm infants (VPIs) in China are lacking. OBJECTIVE To assess the care practices in NICUs and outcomes among VPIs in China. DESIGN, SETTING, AND PARTICIPANTS A cohort study was conducted comprising 57 tertiary hospitals from 25 provinces throughout China. All infants with gestational age (GA) less than 32 weeks who were admitted to the 57 NICUs between January 1 and December 31, 2019, were included. MAIN OUTCOMES AND MEASURES Care practices, morbidities, and survival were the primary outcomes of the study. Major morbidities included bronchopulmonary dysplasia, severe intraventricular hemorrhage (grade ≥3) and/or periventricular leukomalacia, necrotizing enterocolitis (stage ≥2), sepsis, and severe retinopathy of prematurity (stage ≥3). RESULTS A total of 9552 VPIs were included, with mean (SD) GA of 29.5 (1.7) weeks and mean (SD) birth weight of 1321 (321) g; 5404 infants (56.6%) were male. Antenatal corticosteroids were used in 75.6% (6505 of 8601) of VPIs, and 54.8% (5211 of 9503)were born through cesarean delivery. In the delivery room, 12.1% of VPIs received continuous positive airway pressure and 26.7% (2378 or 8923) were intubated. Surfactant was prescribed for 52.7% of the infants, and postnatal dexamethasone was prescribed to 9.5% (636 of 6675) of the infants. A total of 85.5% (8171) of the infants received complete care, and 14.5% (1381) were discharged against medical advice. The incidences of the major morbidities were bronchopulmonary dysplasia, 29.2% (2379 of 8148); severe intraventricular hemorrhage and/or periventricular leukomalacia, 10.4% (745 of 7189); necrotizing enterocolitis, 4.9% (403 of 8171 ); sepsis, 9.4% (764 of 8171); and severe retinopathy of prematurity, 4.3% (296 of 6851) among infants who received complete care. Among VPIs with complete care, 95.4% (7792 of 8171) survived: 65.6% (155 of 236) at 25 weeks' or less GA, 89.0% (880 of 988) at 26 to 27 weeks' GA, 94.9% (2635 of 2755)at 28 to 29 weeks' GA, and 98.3% (4122 of 4192) at 30 to 31 weeks' GA. Only 57.2% (4677 of 8171) of infants survived without major morbidity: 10.5% (25 of 236) at 25 weeks' or less GA, 26.8% (48 of 179) at 26 to 27 weeks' GA, 51.1% (1409 of 2755) at 28 to 29 weeks' GA, and 69.3% (2904 of 4192) at 30 to 31 weeks' GA. Among all infants admitted, the survival rate was 87.6% (8370 of 9552)and survival without major morbidities was 51.8% (4947 of 9552). CONCLUSIONS AND RELEVANCE The findings of this study suggest that survival and survival without major morbidity of VPIs in Chinese NICUs have improved but remain lower than in high-income countries. Comprehensive and targeted quality improvement efforts are needed to provide complete care for all VPIs, optimize obstetrical and neonatal care practices, and improve outcomes.
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Affiliation(s)
- Yun Cao
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Jianhua Sun
- Division of Neonatology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyan Hei
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Laishuan Wang
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Huayan Zhang
- Division of Neonatology, Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children’s Medical Center, Guangdong, China
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Xiaolu Ma
- Division of Neonatology, The Children’s Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Hui Wu
- Division of Neonatology, The First Bethune Hospital of Jilin University, Jilin, China
| | - Xiaoying Li
- Division of Neonatology, Qilu Children’s Hospital of Shandong University, Shandong, China
| | - Huiqing Sun
- Division of Neonatology, Children’s Hospital Affiliated with Zhengzhou University, Children’s Hospital of Henan Zhengzhou, Hennan, China
| | - Wei Zhou
- Division of Neonatology, Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children’s Medical Center, Guangdong, China
| | - Yuan Shi
- Division of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yanchen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai, China
| | - Xinyue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children’s Hospital of Fudan University, Shanghai, China
| | - Tongling Yang
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Yulan Lu
- Center for Molecular Medicine, Pediatrics Research Institute, Children’s Hospital of Fudan University, Shanghai, China
| | - Lizhong Du
- Division of Neonatology, The Children’s Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Chao Chen
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
| | - Shoo K. Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wenhao Zhou
- Division of Neonatology, Children’s Hospital of Fudan University, Shanghai, China
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Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation. J Pediatr 2021; 235:34-41.e1. [PMID: 33741365 DOI: 10.1016/j.jpeds.2021.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at <26 weeks of gestation or <750 g birth weight. STUDY DESIGN We conducted a retrospective study of preterm infants admitted to Canadian Neonatal Network units between 2010 and 2018. Infants were classified into 2 groups based on receipt of antenatal steroids; the latter subgrouped as recent (≤7 days before birth) or latent (>7 days before birth) exposures. The co-exposure was prophylactic indomethacin. The primary outcome was SIP. Multivariable logistic regression analysis was used to calculate aORs. RESULTS Among 4720 eligible infants, 4121 (87%) received antenatal steroids and 1045 (22.1%) received prophylactic indomethacin. Among infants exposed to antenatal steroids, those who received prophylactic indomethacin had higher odds of SIP (aOR 1.61, 95% CI 1.14-2.28) compared with no prophylactic indomethacin. Subgroup analyses revealed recent antenatal steroids exposure with prophylactic indomethacin had higher odds of SIP (aOR 1.67, 95% CI 1.15-2.43), but latent antenatal steroids exposure with prophylactic indomethacin did not (aOR 1.24, 95% CI 0.48-3.21), compared with the respective groups with no prophylactic indomethacin. Among those not exposed to antenatal steroids, mortality was lower among those who received prophylactic indomethacin (aOR 0.45, 95% CI 0.28-0.73) compared with no prophylactic indomethacin. CONCLUSIONS In preterm neonates of <26 weeks of gestation or birth weight <750 g, co-exposure of antenatal steroids and prophylactic indomethacin was associated with SIP, especially if antenatal steroids was received within 7 days before birth. Among those unexposed to antenatal steroids, prophylactic indomethacin was associated with lower odds of mortality.
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Thomas S, Asztalos E. Gestation-Based Viability-Difficult Decisions with Far-Reaching Consequences. CHILDREN (BASEL, SWITZERLAND) 2021; 8:593. [PMID: 34356572 PMCID: PMC8304356 DOI: 10.3390/children8070593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3-7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider's decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority-identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability.
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Affiliation(s)
- Sumesh Thomas
- Department of Pediatrics, Section of Neonatology, University of Calgary, C536-1403 29St Nw, Calgary, AB T2N 2T9, Canada
| | - Elizabeth Asztalos
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, M4-230, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada;
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Boutin A, Lisonkova S, Muraca GM, Razaz N, Liu S, Kramer MS, Joseph KS. Bias in comparisons of mortality among very preterm births: A cohort study. PLoS One 2021; 16:e0253931. [PMID: 34191860 PMCID: PMC8244917 DOI: 10.1371/journal.pone.0253931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several studies of prenatal determinants and neonatal morbidity and mortality among very preterm births have resulted in unexpected and paradoxical findings. We aimed to compare perinatal death rates among cohorts of very preterm births (24-31 weeks) with rates among all births in these groups (≥24 weeks), using births-based and fetuses-at-risk formulations. METHODS We conducted a cohort study of singleton live births and stillbirths ≥24 weeks' gestation using population-based data from the United States and Canada (2006-2015). We contrasted rates of perinatal death between women with or without hypertensive disorders, between maternal races, and between births in Canada vs the United States. RESULTS Births-based perinatal death rates at 24-31 weeks were lower among hypertensive than among non-hypertensive women (rate ratio [RR] 0.67, 95% CI 0.65-0.68), among Black mothers compared with White mothers (RR 0.94, 95%CI 0.92-0.95) and among births in the United States compared with Canada (RR 0.74, 95%CI 0.71-0.75). However, overall (≥24 weeks) perinatal death rates were higher among births to hypertensive vs non-hypertensive women (RR 2.14, 95%CI 2.10-2.17), Black vs White mothers (RR 1.86, 95%CI 184-1.88;) and births in the United States vs Canada (RR 1.08, 95%CI 1.05-1.10), as were perinatal death rates based on fetuses-at-risk at 24-31 weeks (RR for hypertensive disorders: 2.58, 95%CI 2.53-2.63; RR for Black vs White ethnicity: 2.29, 95%CI 2.25-2.32; RR for United States vs Canada: 1.27, 95%CI 1.22-1.30). CONCLUSION Studies of prenatal risk factors and between-centre or between-country comparisons of perinatal mortality bias causal inferences when restricted to truncated cohorts of very preterm births.
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Affiliation(s)
- Amélie Boutin
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and Health Centre, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and Health Centre, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Giulia M. Muraca
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and Health Centre, and the University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Neda Razaz
- Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Shiliang Liu
- Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Michael S. Kramer
- Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - K. S. Joseph
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and Health Centre, and the University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Ankermann T, Longardt AC. Langzeitmanagement bei bronchopulmonaler Dysplasie. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01202-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seaton SE, Draper ES, Adams M, Kusuda S, Håkansson S, Helenius K, Reichman B, Lehtonen L, Bassler D, Lee SK, Vento M, Darlow BA, Rusconi F, Beltempo M, Isayama T, Lui K, Norman M, Yang J, Shah PS, Modi N. Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks. J Pediatr 2021; 233:26-32.e6. [PMID: 33600820 DOI: 10.1016/j.jpeds.2021.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. CONCLUSIONS We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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Ruys CA, van de Lagemaat M, Rotteveel J, Finken MJJ, Lafeber HN. Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice. Eur J Pediatr 2021; 180:1665-1673. [PMID: 33517483 PMCID: PMC8105221 DOI: 10.1007/s00431-021-03950-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
Preterm-born children are at risk for later neurodevelopmental problems and cardiometabolic diseases; early-life growth restriction and suboptimal neonatal nutrition have been recognized as risk factors. Prevention of these long-term sequelae has been the focus of intervention studies. High supplies of protein and energy during the first weeks of life (i.e., energy > 100 kcal kg-1 day-1 and a protein-to-energy ratio > 3 g/100 kcal) were found to improve both early growth and later neurodevelopmental outcome. Discontinuation of this high-energy diet is advised beyond 32-34 weeks postconceptional age to prevent excess fat mass and possible later cardiometabolic diseases. After discharge, nutrition with a higher protein-to-energy ratio (i.e., > 2.5-3.0 g/100 kcal) may improve growth and body composition in the short term.Conclusion: Preterm infants in their first weeks of life require a high-protein high-energy diet, starting shortly after birth. Subsequent adjustments in nutritional composition, aimed at achieving optimal body composition and minimizing the long-term cardiometabolic risks without jeopardizing the developing brain, should be guided by the growth pattern. The long-term impact of this strategy needs to be studied. What is Known: • Preterm infants are at risk for nutritional deficiencies and extrauterine growth restriction. • Extrauterine growth restriction and suboptimal nutrition are risk factors for neurodevelopmental problems and cardiometabolic disease in later life. What is New: • Postnatally, a shorter duration of high-energy nutrition may prevent excess fat mass accretion and its associated cardiometabolic risks and an early switch to a protein-enriched diet should be considered from 32-34 weeks postconceptional age. • In case of formula feeding, re-evaluate the need for the continuation of a protein-enriched diet, based on the infant's growth pattern.
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Affiliation(s)
- Charlotte A. Ruys
- Department of Pediatrics/Neonatology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Monique van de Lagemaat
- Department of Pediatrics/Neonatology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Joost Rotteveel
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Martijn J. J. Finken
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Harrie N. Lafeber
- Department of Pediatrics/Neonatology, Emma Children’s Hospital, Amsterdam UMC, VU University Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Chen S, Wu R, Chen H, Ma W, Du S, Li C, Lu X, Feng S. Validation of the DIGIROP-birth model in a Chinese cohort. BMC Ophthalmol 2021; 21:236. [PMID: 34044820 PMCID: PMC8161896 DOI: 10.1186/s12886-021-01952-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/14/2021] [Indexed: 01/18/2023] Open
Abstract
Background We aimed to validate the predictive performance of the DIGIROP-Birth model for identifying treatment-requiring retinopathy of prematurity (TR-ROP) in Chinese preterm infants to evaluate its generalizability across countries and races. Methods We retrospectively reviewed the medical records of preterm infants who were screened for retinopathy of prematurity (ROP) in a single Chinese hospital between June 2015 and August 2020. The predictive performance of the model for TR-ROP was assessed through the construction of a receiver-operating characteristic (ROC) curve and calculating the areas under the ROC curve (AUC), sensitivity, specificity, and positive and negative predictive values. Results Four hundred and forty-two infants (mean (SD) gestational age = 28.8 (1.3) weeks; mean (SD) birth weight = 1237.0 (236.9) g; 64.7% males) were included in the study. Analyses showed that the DIGIROP-Birth model demonstrated less satisfactory performance than previously reported in identifying infants with TR-ROP, with an area under the receiver-operating characteristic curve of 0.634 (95% confidence interval = 0.564–0.705). With a cutoff value of 0.0084, the DIGIROP-Birth model showed a sensitivity of 48/93 (51.6%), which increased to 89/93 (95.7%) after modification with the addition of postnatal risk factors. In infants with a gestational age < 28 weeks or birth weight < 1000 g, the DIGIROP-Birth model exhibited sensitivities of 36/39 (92.3%) and 20/23 (87.0%), respectively. Conclusions Although the predictive performance was less satisfactory in China than in developed countries, modification of the DIGIROP-Birth model with postnatal risk factors shows promise in improving its efficacy for TR-ROP. The model may also be effective in infants with a younger gestational age or with an extremely low birth weight. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01952-0.
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Affiliation(s)
- Sizhe Chen
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No.253 Gongyedadao Middle Road, Guangzhou, 510282, Guangdong, China
| | - Rong Wu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No.253 Gongyedadao Middle Road, Guangzhou, 510282, Guangdong, China
| | - He Chen
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No.253 Gongyedadao Middle Road, Guangzhou, 510282, Guangdong, China.,Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
| | - Wenbei Ma
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No.253 Gongyedadao Middle Road, Guangzhou, 510282, Guangdong, China
| | - Shaolin Du
- Department of Ophthalmology, Tung Wah Hospital, Sun Yat-sen University, Dongguan, China
| | - Chao Li
- Department of Ophthalmology, Tung Wah Hospital, Sun Yat-sen University, Dongguan, China
| | - Xiaohe Lu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No.253 Gongyedadao Middle Road, Guangzhou, 510282, Guangdong, China.
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No.253 Gongyedadao Middle Road, Guangzhou, 510282, Guangdong, China.
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Yoneda N, Isayama T, Saito S, Shah PS, Santaguida P, Nakamura T, McDonald SD. Learning From Strengths: Improving Care by Comparing Perinatal Approaches Between Japan and Canada and Identifying Future Research Priorities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1388-1394.e1. [PMID: 34020070 DOI: 10.1016/j.jogc.2021.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Preterm birth (PTB) is the leading cause of infant morbidity and mortality worldwide. Canada and Japan each have strengths that can inform clinical decision-making, research, and health care policy regarding the prevention of PTB and its sequelae. Our objectives were to: 1) compare PTB rates, risk factors, management, and outcomes between Japan and Canada; 2) establish research priorities while fostering future collaborative opportunities; and 3) undertake knowledge translation of these findings. METHODS We conducted a literature review to identify publications that examined PTB rates, risk factors, prevention and management techniques, and outcomes in Japan and Canada. We conducted site visits at 4 Japanese tertiary centres and held a collaborative stakeholder meeting of parents, neonatologists, maternal-fetal medicine specialists, and researchers. RESULTS Japan reports lower rates of PTB, neonatal mortality, and several PTB risk factors than Canada. However, Canadian PTB data is population-based, whereas, in Japan, the rate of PTB is population-based, but outcomes are not. Rates of severe neurologic injury and necrotizing enterocolitis were lower in Japan, while Canada's rates of bronchopulmonary dysplasia and retinopathy of prematurity were lower. PTB prevention approaches differed, with less progesterone use in Japan and more long-term tocolysis. In Japan, there were lower rates of neonatal transfers and non-faculty overnight care, but also less use of antenatal corticosteroids and deferred cord clamping. Research priorities identified through the stakeholder meeting included early skin-to-skin contact, parental well-being after PTB, and transitions in care for the child. CONCLUSION We identified key differences between Japan and Canada in the factors affecting PTB management and patient outcomes, which can inform future research efforts.
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Affiliation(s)
- Noriko Yoneda
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON
| | - Pasqualina Santaguida
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON; Department of Rehabilitation Sciences, McMaster University, Hamilton, ON
| | - Tomohiko Nakamura
- Division of Neonatology, Department of Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Sarah D McDonald
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Hamilton, ON.
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Chen TT, Tsou KI, Jim W, Chen CN. Risk-adjusted rates between hospitals for adverse outcomes of very-low-birth-weight infants. J Formos Med Assoc 2021; 120:1855-1862. [PMID: 33962810 DOI: 10.1016/j.jfma.2021.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/PURPOSE To analyze the amount of variation in these risk-adjusted adverse outcomes corresponding to the care of premature births. In addition, hospitals were ranked according to their unadjusted and adjusted rates, and we assessed the degree of concordance between these rankings. Finally, the correlations of hospital-adjusted adverse outcomes were also tested. METHODS The study utilized the 5-year Taiwan Premature Infant Follow-up Network (TPFN) database in Taiwan from 2014 to 2018, and the sample size was 6482. We calculated the "observed over expected" (OE) ratio every year to form the risk-adjusted adverse outcome rate for each hospital. RESULTS There was a larger variation in the risk-adjusted rate for NEC and the second-largest variation for IVH. Regarding the concordances between the unadjusted and adjusted ranks, the ranks for mortality had the lowest concordance (coefficient of concordance 0.64), and only a few of the risk-adjusted rates between outcomes were significantly correlated. CONCLUSION The results of the TPFN show that there is room to improve performance in terms of large variations in NEC and IVH. Furthermore, risk adjustment is important, especially for mortality, since the ranks for mortality have the lowest concordance. Finally, we cannot generate a conclusion regarding whether a hospital is high in quality if we only take 1 or 2 adverse outcomes as profiling measures because only a few of the risk-adjusted rates between outcomes were significantly correlated.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Kuo-Inn Tsou
- Coordinator of Taiwan Premature Infant Follow-up Network, Taipei, Taiwan; Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Waitim Jim
- Division of Neonatology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chi-Nien Chen
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Taiwan
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Abstract
Despite important advances in neonatal care, rates of bronchopulmonary dysplasia (BPD) have remained persistently high. Numerous drugs and ventilator strategies are used for the prevention and treatment of BPD. Some, such as exogenous surfactant, volume targeted ventilation, caffeine, and non-invasive respiratory support, are associated with modest but important reductions in rates of BPD and long-term respiratory morbidities. Many other therapies, such as corticosteroids, diuretics, nitric oxide, bronchodilators and anti-reflux medications, are widely used despite conflicting, limited or no evidence of efficacy and safety. This paper examines the range of therapies used for the prevention or treatment of BPD. They are classified into those supported by evidence of effectiveness, and those which are widely used despite limited evidence or unclear risk to benefit ratios. Finally, the paper explores emerging therapies and approaches which aim to prevent or reduce BPD and long-term respiratory morbidity.
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Yue G, Wu Y, Zhao F, Zhang C, Zhao D, Lu J, Fang Q, Li X, Wei Y, Qian M, Yi L, Zheng S, Ba R, Luo L, Luo J, Zhao S, Lu J, Huang X, Wei G, Xi Y, Gao S, Hu X, Ju R. A 3-armed multicenter randomized controlled trial: Placental Transfusion in Very Preterm Infants (PT-VPI). Contemp Clin Trials 2021; 103:106337. [PMID: 33662589 DOI: 10.1016/j.cct.2021.106337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Preterm infants constitute an important proportion of neonatal deaths and various complications, and very preterm infants (VPI) are more likely to develop severe complications, such as intraventricular hemorrhage (IVH), anemia, and sepsis. It has been confirmed that placental transfusion can supplement blood volume in infants and reduce preterm-associated complications, which is further conducive to the development of the nervous system and a better long-term prognosis. Based on these advantages, placental transfusion has been widely used in VPI. There are three main types of placental transfusion: delayed cord clamping (DCC), intact umbilical cord milking (I-UCM), and cut umbilical cord milking (C-UCM). However, the optimal method for PT-VPI remains controversial, and it is urgent to identify the best method of placental transfusion. We plan to fully evaluate the safety and effectiveness of these three placental transfusion methods in VPI in a 3-arm multicenter randomized controlled trial: Placental Transfusion in Very Preterm Infants (PT-VPI). Trial registration: chictr.org.cn, number ChiCTR2000030953.
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Affiliation(s)
- Guang Yue
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yan Wu
- Neonatal Department, Chongqing Health Center for Women and Children, Chongqing, PR China
| | - Fangping Zhao
- Neonatal Department, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, PR China
| | - Chunyi Zhang
- Neonatal Department, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Dan Zhao
- Neonatal Department, Maternity and Child-Care Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China
| | - Jingjie Lu
- Neonatal Department, Guiyang Maternal and Child Health Hospital, Guizhou, PR China
| | - Qiaoyan Fang
- Neonatal Department, Hunan Provincial Maternal and Child Healthcare Hospital, Changsha, PR China
| | - Xia Li
- Neonatal Department, Jinan Maternity and Child-Care Hospital, Jinan, PR China
| | - Yijun Wei
- Neonatal Department, Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, PR China
| | - Miao Qian
- Neonatal Department, Nanjing Maternity and Child Health Care Hospital, Nanjing, PR China
| | - Lin Yi
- Neonatal Department, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, PR China
| | - Shan Zheng
- Neonatal Department, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, PR China
| | - Ruihua Ba
- Neonatal Department, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, PR China
| | - Liqian Luo
- Neonatal Department, Northwest Women's and Children's Hospital, Xi'an, PR China
| | - Jiping Luo
- Neonatal Department, Xichang People's Hospital, Xichang, PR China
| | - Shuai Zhao
- Neonatal Department, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China
| | - Jiangyi Lu
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Xia Huang
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Guoqing Wei
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Yufeng Xi
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Shuqiang Gao
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Xuhong Hu
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China
| | - Rong Ju
- Neonatal Department, Chengdu Women's and Children's Central Hospital, School of Medicine, School of Medicine, University of Electronic Science and Technology of China, Chengdu, PR China.
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Hirata K, Kimura T, Hirano S, Wada K, Kusuda S, Fujimura M. Outcomes of outborn very-low-birth-weight infants in Japan. Arch Dis Child Fetal Neonatal Ed 2021; 106:131-136. [PMID: 32788390 DOI: 10.1136/archdischild-2019-318594] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Outcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain. OBJECTIVE To compare morbidity and mortality between outborn and inborn VLBWIs. DESIGN Observational cohort study using inverse-probability-of-treatment weighting. SETTING Neonatal Research Network of Japan. PATIENTS Singleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016. METHODS Inverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality. RESULTS The full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4-31.0) weeks and 1128 (862-1351) g for outborns and 28.7 (26.3-30.9) weeks and 1042 (758-1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality. CONCLUSION Outborn delivery of VLBWIs was associated with an increased risk of severe IVH.
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Affiliation(s)
- Katsuya Hirata
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Takeshi Kimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinya Hirano
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Kazuko Wada
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | | | - Masanori Fujimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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El Damaty A, Giannoni L, Unterberg A, Baechli H. Thrombocytopenia: is it a prognostic factor for development of post-hemorrhagic hydrocephalus in neonates? Childs Nerv Syst 2021; 37:519-527. [PMID: 32661644 PMCID: PMC7358285 DOI: 10.1007/s00381-020-04790-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Post-hemorrhagic hydrocephalus (PHH) is a rare but serious complication among premature babies in the neonatal intensive care unit. The causes of PHH are still not entirely understood, and its prevention and treatment are controversial. We tried to analyze the risk factors for such complication in our cohort. METHODS We reviewed our neonatology data bank and included all preterms below 28 weeks who were born in the period between 1999 and 2014 and suffered from an intraventricular hemorrhage (IVH). We reviewed gestational age, gender, birth weight, type of birth, IVH degree, comorbidities, therapy, complications, time to event, protein content of cerebrospinal fluid, and clinical follow-up. RESULTS We identified 180 patients, divided into two subgroups, "B1" with 37 cases (IVH + PHH) and "B2" with 143 cases (IVH - PHH). In group B1, the presence of IVH grades I, II, III, or IV was in 11%, 19%, and 70% respectively. Nineteen patients were treated with a ventricular access device (VAD) or external ventricular drain (EVD). A total of 20 shunts were implanted, with 11 revisions (55%). One patient suffered from thrombocytopenia. In subgroup B2, 51% showed IVH grade I, whereas severe IVH grades were only present in 22%. 25.9% suffered from thrombocytopenia. Thrombocytopenia was significantly higher in patients who did not develop PHH (p value: 0.002). CONCLUSION According to our results, thrombocytopenia could play a decisive role in avoiding development of PHH as a sequel of IVH. We recommend a randomized controlled trial to assess the possible efficacy of antiplatelet drugs in avoiding PHH in this vulnerable group.
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Affiliation(s)
- Ahmed El Damaty
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Luca Giannoni
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Heidi Baechli
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Backes CH, Rivera BK, Pavlek L, Beer LJ, Ball MK, Zettler ET, Smith CV, Bridge JA, Bell EF, Frey HA. Proactive neonatal treatment at 22 weeks of gestation: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224:158-174. [PMID: 32745459 DOI: 10.1016/j.ajog.2020.07.051] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this study was to provide a systematic review and meta-analysis to quantify prognosis and identify factors associated with variations in reported mortality estimates among infants who were born at 22 weeks of gestation and provided proactive treatment (resuscitation and intensive care). DATA SOURCES PubMed, Scopus, and Web of Science databases, with no language restrictions, were searched for articles published from January 2000 to February 2020. STUDY ELIGIBILITY CRITERIA Reports on live-born infants who were delivered at 22 weeks of gestation and provided proactive care were included. The primary outcome was survival to hospital discharge; secondary outcomes included survival without major morbidity and survival without neurodevelopmental impairment. Because we expected differences across studies in the definitions for various morbidities, multiple definitions for composite outcomes of major morbidities were prespecified. Neurodevelopmental impairment was based on Bayley Scales of Infant Development II or III. Data extractions were performed independently, and outcomes agreed on a priori. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality was assessed using the Quality in Prognostic Studies tool. An adapted version of the Grading of Recommendations Assessment, Development and Evaluation approach for prognostic studies was used to evaluate confidence in overall estimates. Outcomes were assessed as prevalence and 95% confidence intervals. Variabilities across studies attributable to heterogeneity were estimated with the I2 statistic; publication bias was assessed with the Luis Furuya-Kanamori index. Data were pooled using the inverse variance heterogeneity model. RESULTS Literature searches returned 21,952 articles, with 2034 considered in full; 31 studies of 2226 infants who were delivered at 22 weeks of gestation and provided proactive neonatal treatment were included. No articles were excluded for study design or risk of bias. The pooled prevalence of survival was 29.0% (95% confidence interval, 17.2-41.6; 31 studies, 2226 infants; I2=79.4%; Luis Furuya-Kanamori index=0.04). Survival among infants born to mothers receiving antenatal corticosteroids was twice the survival of infants born to mothers not receiving antenatal corticosteroids (39.0% vs 19.5%; P<.01). The overall prevalence of survival without major morbidity, using a definition that includes any bronchopulmonary dysplasia, was 11.0% (95% confidence interval, 8.0-14.3; 10 studies, 374 infants; I2=0%; Luis Furuya-Kanamori index=3.02). The overall rate of survival without moderate or severe impairment was 37.0% (95% confidence interval, 14.6-61.5; 5 studies, 39 infants; I2=45%; Luis Furuya-Kanamori index=-0.15). Based on the year of publication, survival rates increased between 2000 and 2020 (slope of the regression line=0.09; standard error=0.03; P<.01). Studies were highly diverse with regard to interventions and outcomes reported. CONCLUSION The reported survival rates varied greatly among studies and were likely influenced by combining observational data from disparate sources, lack of individual patient-level data, and bias in the component studies from which the data were drawn. Therefore, pooled results should be interpreted with caution. To answer fundamental questions beyond the breadth of available data, multicenter, multidisciplinary collaborations, including alignment of important outcomes by stakeholders, are needed.
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Affiliation(s)
- Carl H Backes
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH; The Heart Center, Nationwide Children's Hospital, Columbus, OH.
| | - Brian K Rivera
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Leanne Pavlek
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lindsey J Beer
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Molly K Ball
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eli T Zettler
- Centers for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Jeffrey A Bridge
- Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Edward F Bell
- Department of Pediatrics, University of Iowa; Iowa City, IA
| | - Heather A Frey
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
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Kusuda S, Bennett M, Gould J. Outcomes of Infants with Very Low Birth Weight Associated with Birthplace Difference: A Retrospective Cohort Study of Births in Japan and California. J Pediatr 2021; 229:182-190.e6. [PMID: 33058856 DOI: 10.1016/j.jpeds.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity. STUDY DESIGN Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California). RESULTS Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity. CONCLUSIONS Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes.
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Affiliation(s)
- Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan.
| | - Mihoko Bennett
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
| | - Jeffrey Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
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Lui K, Vento M, Modi N, Kusuda S, Lehtonen L, Håkansson S, Rusconi F, Bassler D, Reichman B, Yang J, Shah PS. Inter-center variability in neonatal outcomes of preterm infants: A longitudinal evaluation of 298 neonatal units in 11 countries. Semin Fetal Neonatal Med 2021; 26:101196. [PMID: 33526374 DOI: 10.1016/j.siny.2021.101196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Collaboration and cooperation of clinicians and neonatal units at regional, national, and international levels are key features of many networks or systems that aim to improve neonatal outcomes. Network performance is typically assessed by comparing individual, unit-level outcomes. In this paper, we provide insight into another dimension, i.e., inter-center outcome variation in 10 national/regional neonatal collaborations from 11 high-income countries. We illustrate the use of coefficients of variation for evaluation of mortality and a composite outcome of mortality, severe neurological injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia, as a measure of inter-center variation. These inter-center variation estimates could help to identify areas of opportunities and challenges for each country/region; they also provide "macro"-level evaluations that can be useful for clinicians, administrators, managers and policy makers.
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Affiliation(s)
- Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia.
| | - Maximo Vento
- Division of Neonatology and Health Research Institute, University and Polytechnic Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain.
| | - Neena Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, 6-20-2 Mitaka, Tokyo 181-8611, Japan.
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Department of Clinical Medicine, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland.
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, University Hospital, Umeå University, SE-90185 Umeå, Sweden.
| | - Franca Rusconi
- Unit of Epidemiology, Meyer Children's University Hospital, Viale Pieraccini 24, Florence, Italy, 50139.
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
| | - Brian Reichman
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, 52621, Israel.
| | - Jie Yang
- Department of Pediatrics and Maternal-infant Care Research Centre, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5.
| | - Prakesh S Shah
- Department of Pediatrics and Maternal-infant Care Research Centre, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5.
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82
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Ding Y, Chen Z, Lu Y. Vitamin A supplementation prevents the bronchopulmonary dysplasia in premature infants: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23101. [PMID: 33545924 PMCID: PMC7837939 DOI: 10.1097/md.0000000000023101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is necessary to evaluate the effectiveness and safety of vitamin A supplementation on the bronchopulmonary dysplasia (BPD) in premature infants. METHODS Randomized controlled trials (RCTs) on the role of supplemental vitamin A in preterm infants were searched. The Medline et al databases were manually searched from inception to April 30, 2020. Related outcomes including incidence of BPD, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), sepsis and mortality were assessed with Review Manager 5.3 software, and Random-effect model was applied for all conditions. RESULTS A total of 9 RCTs with 1409 patients were included. The analyzed results showed that the incidence of BPD in vitamin A group was significantly less than that of control group (OR = 0.67, 95%CI [0.52-0.88]). There was no significant difference in the incidence of ROP (OR = 0.65, 95%CI [0.29-1.48]), NEC (OR = 0.88, 95%CI [0.59-1.30]), IVH (OR = 0.90, 95%CI [0.65-1.25]), sepsis (OR = 0.84, 95%CI [0.64-1.09]) and mortality (OR = 0.98, 95%CI [0.72-1.34]) among two groups. CONCLUSION Vitamin A supplementation is beneficial to the prophylaxis of BPD in premature infants, further studies on the administration approaches and dosages of vitamin A in premature infants are warranted.
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83
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Mohammad K, Scott JN, Leijser LM, Zein H, Afifi J, Piedboeuf B, de Vries LS, van Wezel-Meijler G, Lee SK, Shah PS. Consensus Approach for Standardizing the Screening and Classification of Preterm Brain Injury Diagnosed With Cranial Ultrasound: A Canadian Perspective. Front Pediatr 2021; 9:618236. [PMID: 33763394 PMCID: PMC7982529 DOI: 10.3389/fped.2021.618236] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 12/16/2022] Open
Abstract
Acquired brain injury remains common in very preterm infants and is associated with significant risks for short- and long-term morbidities. Cranial ultrasound has been widely adopted as the first-line neuroimaging modality to study the neonatal brain. It can reliably detect clinically significant abnormalities that include germinal matrix and intraventricular hemorrhage, periventricular hemorrhagic infarction, post-hemorrhagic ventricular dilatation, cerebellar hemorrhage, and white matter injury. The purpose of this article is to provide a consensus approach for detecting and classifying preterm brain injury to reduce variability in diagnosis and classification between neonatologists and radiologists. Our overarching goal with this work was to achieve homogeneity between different neonatal intensive care units across a large country (Canada) with regards to classification, timing of brain injury screening and frequency of follow up imaging. We propose an algorithmic approach that can help stratify different grades of germinal matrix-intraventricular hemorrhage, white matter injury, and ventricular dilatation in very preterm infants.
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Affiliation(s)
- Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - James N Scott
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Lara M Leijser
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Hussein Zein
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Université Laval and Centre de recherche du CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Brain Center, University Utrecht, Utrecht, Netherlands
| | | | - Shoo K Lee
- Department of Pediatrics, Mount Sinai hospital, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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El Faleh I, Faouzi M, Adams M, Gerull R, Chnayna J, Giannoni E, Roth-Kleiner M. Bronchopulmonary dysplasia: a predictive scoring system for very low birth weight infants. A diagnostic accuracy study with prospective data collection. Eur J Pediatr 2021; 180:2453-2461. [PMID: 33822247 PMCID: PMC8285318 DOI: 10.1007/s00431-021-04045-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 01/17/2023]
Abstract
Our aim was to develop and validate a predictive risk score for bronchopulmonary dysplasia (BPD), according to two clinically used definitions: 1. Need for supplementary oxygen during ≥ 28 cumulative days, BPD28, 2. Need for supplementary oxygen at 36 weeks postmenstrual age (PMA), BPD36. Logistic regression was performed in a national cohort (infants born in Switzerland with a birth weight < 1501 g and/or between 23 0/7 and 31 6/7 weeks PMA in 2009 and 2010), to identify predictors of BPD. We built the score as the sum of predicting factors, weighted according to their ORs, and analysed its discriminative properties by calculating the area under the ROC (receiver operating characteristic) curves (AUCs). This score was then applied to the Swiss national cohort from the years 2014-2015 to perform external validation. The incidence of BPD28 was 21.6% in the derivation cohort (n = 1488) and 25.2% in the validation cohort (n = 2006). The corresponding numbers for BPD36 were 11.3% and 11.1%, respectively. We identified gestational age, birth weight, antenatal corticosteroids, surfactant administration, proven infection, patent ductus arteriosus and duration of mechanical ventilation as independent predictors of BPD28. The AUCs of the BPD risk scores in the derivation cohort were 0.90 and 0.89 for the BPD28 and BPD36 definitions, respectively. The corresponding AUCs in the validation cohort were 0.92 and 0.88, respectively.Conclusion: This score allows for predicting the risk of a very low birth weight infant to develop BPD early in life and may be a useful tool in clinical practice and neonatal research. What is Known: • Many studies have proposed scoring systems to predict bronchopulmonary dysplasia (BPD). • Such a risk prediction may be important to identify high-risk patients for counselling parents, research purposes and to identify candidates for specific treatment. What is New: • A predictive risk score for BPD was developed and validated in a large national multicentre cohort and its performance assessed by two indices of accuracy. • The developed scoring system allows to predict the risk of BPD development early but also at any day of life with high validity.
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Affiliation(s)
- Ikbel El Faleh
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Paediatrics, Hospital Neuchâtel, Neuchâtel, Switzerland
| | - Mohamed Faouzi
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland Gerull
- Department of Neonatology, University Children’s Hospital Basel, Basel, Switzerland
| | - Jamel Chnayna
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Roth-Kleiner
- Clinic of Neonatology, Department Women-Mother-Child, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Al Hazzani F, Al-Alaiyan S, Kattan A, Binmanee A, Jabr MB, Al Midani E, Khadawardi E, Riaz F, Elsaidawi W. Short-term outcome of very low-birth-weight infants in a tertiary care hospital in Saudi Arabia over a decade. J Neonatal Perinatal Med 2020; 14:427-432. [PMID: 33337393 DOI: 10.3233/npm-200534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Knowledge on short-term outcomes of preterm infants is important for quality control. Our objective was to analyze the outcomes of very low birth weight infants admitted to our neonatal intensive care unit over a ten years' period and to compare the results with internationally published data. METHODS We analyzed the outcome measures for all live born infants with birth weight (BW) of 400-1500 grams and gestational age (GA) of 23-32 weeks born at King Faisal Specialist Hospital & Research Centre between 2006 and 2015. Results were compared to data from four international neonatal networks. RESULTS During the study period, we admitted 528 infants born at a gestational age of≥23 and≤32 weeks with a very low birth weight (VLBW) of 400-1500 grams. Mean (SD) GA was 28 (2.4) weeks and mean (SD) BW was 1007 (290) grams. A hundred and twenty-nine (24.4%) infants were small for gestational age and major congenital anomalies were present in 56 (10.6 %) infants. The rate of bronchopulmonary dysplasia (BPD) was 24.4 %, necrotizing enterocolitis (NEC) 9.1%, patent ductus arteriosus (PDA) 29.9%, severe intraventricular hemorrhage (IVH)10.8 %, periventricular leukomalacia (PVL) 5.7%, severe retinopathy of prematurity (ROP) 8%, and late-onset sepsis was 18.8%. The incidences of major neonatal outcomes such as CLD, NEC, severe IVH and severe ROP were comparable to the international cohorts. CONCLUSION In our population of preterm infants, survival rates and complications of prematurity were comparable to international data.
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Affiliation(s)
- F Al Hazzani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - S Al-Alaiyan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Kattan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Binmanee
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M B Jabr
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - E Al Midani
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - E Khadawardi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - F Riaz
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - W Elsaidawi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Influence of perinatal complications on the development of a sample of 36-month-old premature infants. Infant Behav Dev 2020; 62:101507. [PMID: 33271470 DOI: 10.1016/j.infbeh.2020.101507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The lack of clear results in previous studies for this context makes us consider an exploratory study. The objective of this research is to examine the influence of certain perinatal factors on the development of premature infants over their first 36 months of life. METHOD The sample consisted of 59 preterm infants born between 25 and 34 weeks of gestational age in an NICU of a third-level hospital. At 36 months of age, the Bayley-III Infant Development Scale (Spanish adaptation) and a clinical history were collected. RESULTS The average scores on the Bayley-III Infant Development Scale were generally within the normal range, but significantly lower than normal for Fine Motor Function, Gross Motor Function, and Expressive Language. These differences remained when considering the degree of prematurity, gender, and perinatal complications. Infants who received mechanical ventilation, oxygen therapy or corticosteroid treatment due to bronchopulmonary dysplasia showed the greatest discrepancies from normal levels. CONCLUSION Our results support prior studies that show that a combination of perinatal risk factors constitutes the largest determinant for developmental issues at 36 months of age. This information establishes the need for a priority follow-up in this population beyond 24 months of corrected age.
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87
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Volpe J. Commentary – Severe IVH: Time for newer, earlier interventions to prevent brain injury? J Neonatal Perinatal Med 2020; 13:435-439. [PMID: 32925116 PMCID: PMC7836057 DOI: 10.3233/npm-200539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J.J. Volpe
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Pediatric Newborn Medicine, Harvard Medical School, Boston, MA, USA
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88
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Lehtonen L, Lee SK, Kusuda S, Lui K, Norman M, Bassler D, Håkansson S, Vento M, Darlow BA, Adams M, Puglia M, Isayama T, Noguchi A, Morisaki N, Helenius K, Reichman B, Shah PS. Family Rooms in Neonatal Intensive Care Units and Neonatal Outcomes: An International Survey and Linked Cohort Study. J Pediatr 2020; 226:112-117.e4. [PMID: 32525041 DOI: 10.1016/j.jpeds.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the proportion of neonatal intensive care units with facilities supporting parental presence in their infants' rooms throughout the 24-hour day (ie, infant-parent rooms) in high-income countries and to analyze the association of this with outcomes of extremely preterm infants. STUDY DESIGN In this survey and linked cohort study, we analyzed unit design and facilities for parents in 10 neonatal networks of 11 countries. We compared the composite outcome of mortality or major morbidity, length of stay, and individual morbidities between neonates admitted to units with and without infant-parent rooms by linking survey responses to patient data from 2015 for neonates of less than 29 weeks of gestation. RESULTS Of 331 units, 13.3% (44/331) provided infant-parent rooms. Patient-level data were available for 4662 infants admitted to 159 units in 7 networks; 28% of the infants were cared for in units with infant-parent rooms. Neonates from units with infant-parent rooms had lower odds of mortality or major morbidity (aOR, 0.76; 95% CI, 0.64-0.89), including lower odds of sepsis and bronchopulmonary dysplasia, than those from units without infant-parent rooms. The adjusted mean length of stay was 3.4 days shorter (95%, CI -4.7 to -3.1) in the units with infant-parent rooms. CONCLUSIONS The majority of units in high-income countries lack facilities to support parents' presence in their infants' rooms 24 hours per day. The availability vs absence of infant-parent rooms was associated with lower odds of composite outcome of mortality or major morbidity and a shorter length of stay.
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Affiliation(s)
- Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital; and Department of Clinical Medicine, University of Turku, Turku, Finland.
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Departments of Pediatrics and Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Maternal-infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Satoshi Kusuda
- Neonatal Research Network of Japan, Kyorin University, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Maximo Vento
- Division of Neonatology and Health Research Institute of La Fe University Hospital, Valencia, Spain
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monia Puglia
- Unit of Epidemiology, Regional Health Agency, Florence, Italy
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naho Morisaki
- Neonatal Research Network Japan, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital; and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Maternal-infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Boel L, Banerjee S, Clark M, Greenwood A, Sharma A, Goel N, Bagga G, Poon C, Odd D, Chakraborty M. Temporal trends of care practices, morbidity, and mortality of extremely preterm infants over 10-years in South Wales, UK. Sci Rep 2020; 10:18738. [PMID: 33127999 PMCID: PMC7603316 DOI: 10.1038/s41598-020-75749-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Contemporary outcome data of preterm infants are essential to commission, evaluate and improve healthcare resources and outcomes while also assisting professionals and families in counselling and decision making. We analysed trends in clinical practice, morbidity, and mortality of extremely preterm infants over 10 years in South Wales, UK. This population-based study included live born infants < 28 weeks of gestation in tertiary neonatal units between 01/01/2007 and 31/12/2016. Patient characteristics, clinical practices, mortality, and morbidity were studied until death or discharge home. Temporal trends were examined by adjusted multivariable logistic regression models and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). A sensitivity analysis was conducted after excluding infants born at < 24 weeks of gestation. In this population, overall mortality for infants after live birth was 28.2% (267/948). The odds of mortality (aOR 0.93, 95% CI [0.88, 0.99]) and admission to the neonatal unit (0.93 [0.87, 0.98]) significantly decreased over time. Non-invasive ventilation support during stabilisation at birth increased significantly (1.26 [1.15, 1.38]) with corresponding decrease in mechanical ventilation at birth (0.89 [0.81, 0.97]) and following admission (0.80 [0.68–0.96]). Medical treatment for patent ductus arteriosus significantly decreased over the study period (0.90 [0.85, 0.96]). The incidence of major neonatal morbidities remained stable, except for a reduction in late-onset sepsis (0.94 [0.89, 0.99]). Gestation and centre of birth were significant independent factors for several outcomes. The results from our sensitivity analysis were compatible with our main results with the notable exception of death after admission to NICU (0.95 [0.89, 1.01]). There were significant improvements in survival and reduction of late-onset sepsis of extreme preterm infants in South Wales between 2007 and 2016. The sensitivity analysis suggests that some of the temporal changes observed were driven by improved outcomes in the most preterm of infants. Clinical practices related to respiratory support have changed but significant variations in clinical practices and outcomes between centres remain unexplained. The adoption of regional evidence-based clinical guidelines is likely to improve outcomes and reduce variation.
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Affiliation(s)
- Lieve Boel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Sujoy Banerjee
- Neonatal Intensive Care Unit, Singleton Hospital, Swansea, UK
| | - Megan Clark
- School of Medicine, Cardiff University, Cardiff, UK
| | - Annabel Greenwood
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Alok Sharma
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Nitin Goel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Gautam Bagga
- Neonatal Intensive Care Unit, Royal Gwent Hospital, Newport, UK
| | - Chuen Poon
- Neonatal Intensive Care Unit, Royal Gwent Hospital, Newport, UK
| | - David Odd
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK. .,Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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90
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Kim JK, Hwang JH, Lee MH, Chang YS, Park WS. Mortality rate-dependent variations in antenatal corticosteroid-associated outcomes in very low birth weight infants with 23-34 weeks of gestation: A nationwide cohort study. PLoS One 2020; 15:e0240168. [PMID: 33017428 PMCID: PMC7535030 DOI: 10.1371/journal.pone.0240168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
Antenatal corticosteroid (ACS) administration has been known as one of the most effective treatment in perinatal medicine, but the beneficial effects of ACS may vary not only gestational age, but also the quality of perinatal and neonatal care of the institution. This nationwide cohort study of the Korean Neonatal Network (KNN) data was consisted of <1,500g infants born at 23–34 weeks at 67 KNN hospitals between 2013 and 2017. The 9,142 eligible infants were assigned into two groups–group 1 and 2 <50% and ≥50% mortality rate, respectively, for 23–24 weeks’ gestation–reflecting the quality of perinatal and neonatal care. Each group of infants were further stratified into 23–24, 25–26, 27–28, and 29–34 weeks of gestation age. Despite comparable ACS usage between group 1 (82%) and group 2 (81%), the benefits of ACS were only observed in group 1. In the multivariable analyses, infants of group 1 showed significant decrease in mortality and IVH at gestational age 23–24 weeks with ACS use, and the decrease was also seen in early-onset sepsis and respiratory distress syndrome at gestational age of 29–34 weeks while there were no significant decrease in group 2. In this study the overall data was congruent with the previous findings stating that ACS use decreases mortality and morbidity. These results indicate that the improved mortality of infants at 23–24 weeks’ gestation reflects the quality improvement of perinatal and neonatal intensive care, which is a prerequisite to the benefits of ACS.
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Affiliation(s)
- Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
| | - Jong Hee Hwang
- Department of Pediatrics, Ilsan Paik Hospital, InJe University College of Medicine, Goyang, Korea
| | - Myung Hee Lee
- Statistic and Data Center, Samsung Medical Center, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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91
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D'Apremont I, Marshall G, Musalem C, Mariani G, Musante G, Bancalari A, Fabres J, Mena P, Zegarra J, Tavosnanska J, Lacarrubba J, Solana C, Vaz Ferreira C, Herrera T, Villarroel L, Tapia JL. Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers. J Pediatr 2020; 225:44-50.e1. [PMID: 32454113 DOI: 10.1016/j.jpeds.2020.05.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.
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Affiliation(s)
- Ivonne D'Apremont
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile; Neonatal Unit, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Guillermo Marshall
- Departament of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Claudia Musalem
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile
| | - Gonzalo Mariani
- Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Musante
- Maternal and Infant Department, Hospital Universitario Austral, Pilar, Argentina
| | - Aldo Bancalari
- Hospital Guillermo Grant, Concepción, Faculty of Medicine, Universidad de Concepción, Chile
| | - Jorge Fabres
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile
| | - Patricia Mena
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile; Neonatal Unit, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Jaime Zegarra
- Department of Pediatrics, Universidad Cayetano Heredia, Lima, Perú
| | - Jorge Tavosnanska
- Hospital Juan Fernández and Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Claudio Solana
- Division of Neonatology, Hospital RamSardá, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Catalina Vaz Ferreira
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | - Tamara Herrera
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | - Luis Villarroel
- Departament of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - José L Tapia
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile.
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92
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Hua W, Yuwen W, Simoni JM, Yan J, Jiang L. Parental readiness for hospital discharge as a mediator between quality of discharge teaching and parental self-efficacy in parents of preterm infants. J Clin Nurs 2020; 29:3754-3763. [PMID: 32644290 DOI: 10.1111/jocn.15405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self-efficacy in parents of preterm infants. BACKGROUND Parental readiness for hospital discharge and self-efficacy should be considered to establish whether preterm infants and their families are prepared for the discharge. High-quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self-efficacy. DESIGN This was a descriptive cross-sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China. METHODS The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale-Parent Form, and Preterm Parenting and Self-Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study's report. RESULTS Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self-efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self-efficacy by improving parental readiness for discharge. CONCLUSIONS Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching's association with self-efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge and thus promote parental self-efficacy. RELEVANCE TO CLINICAL PRACTICE Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents' knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge.
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Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Weichao Yuwen
- Nursing and Healthcare Leadership, University of Washington Tacoma, Tacoma, WA, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jie Yan
- Neonatology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Chief Nursing Officer, Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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93
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Kawasaki H, Yamada T, Takahashi Y, Nakayama T, Wada T, Kosugi S. The short-term mortality and morbidity of very low birth weight infants with trisomy 18 or trisomy 13 in Japan. J Hum Genet 2020; 66:273-285. [PMID: 32943740 DOI: 10.1038/s10038-020-00825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/09/2022]
Abstract
Trisomy 18 (T18) and trisomy 13 (T13) are major concerns in prenatal genetic testing due to their poor prognosis; very low birth weight (VLBW) is also a concern in neonatology. The aim of this study was to investigate the mortality and morbidity of VLBW infants diagnosed with T18/T13 in Japan, compared with those with no birth defects (BD-). Maternal and neonatal data were collected prospectively from infants weighing <1501 g and were admitted to centers of the Neonatal Research Network of Japan during 2003 to 2016. Among 60,136 infants, 563 and 60 was diagnosed with T18 and T13, respectively. Although the age of mothers of infants with T18/T13 was higher, the frequency of maternal complications was lower than those with BD-. With maternal and neonatal characteristic adjustments, T18/T13 had a higher incidence of each morbidity when compared with BD-. Mortality rates in the NICU were 70, 77, and 5.8% for T18, T13, and BD-, respectively, while the survival discharge rates of T18 and T13 were 29.5 and 23.3%, respectively, which was significantly higher than previous reports. This was the first nationwide survey for VLBW infants with T18/T13 in Japan; this novel data will be relevant and useful for prenatal genetic counseling and perinatal management. Although T18/T13 were considered to be fatal in the past, with proper epidemiological information, discussions with affected families, and compassionate patient care, the mortality rate of T18/T13 can be improved.
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Affiliation(s)
- Hidenori Kawasaki
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takahiro Yamada
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan.
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takahito Wada
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
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94
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van Beek PE, Claessens NHP, Makropoulos A, Groenendaal F, de Vries LS, Counsell SJ, Benders MJNL. Increase in Brain Volumes after Implementation of a Nutrition Regimen in Infants Born Extremely Preterm. J Pediatr 2020; 223:57-63.e5. [PMID: 32389719 DOI: 10.1016/j.jpeds.2020.04.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the effect of early life nutrition on structural brain development in 2 cohorts of extremely preterm infants, before and after the implementation of a nutrition regimen containing more protein and lipid. STUDY DESIGN We included 178 infants retrospectively (median gestational age, 26.6 weeks; IQR, 25.9-27.3), of whom 99 received the old nutrition regimen (cohort A, 2011-2013) and 79 the new nutrition regimen (cohort B, 2013-2015). Intake of protein, lipids, and calories was calculated for the first 28 postnatal days. Brain magnetic resonance imaging (MRI) was performed at 30 weeks postmenstrual age (IQR, 30.3-31.4) and term-equivalent age (IQR, 40.9-41.4). Volumes of 42 (left + right) brain structures were calculated. RESULTS Mean protein and caloric intake in cohort B (3.4 g/kg per day [P < .001] and 109 kcal/kg per day [P = .038]) was higher than in cohort A (2.7 g/kg per day; 104 kcal/kg per day). At 30 weeks, 22 regions were significantly larger in cohort B compared with cohort A, whereas at term-equivalent age, only the caudate nucleus was significantly larger in cohort B compared with cohort A. CONCLUSIONS An optimized nutrition protocol in the first 28 days of life is associated with temporarily improved early life brain volumes.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Nathalie H P Claessens
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Serena J Counsell
- Centre for the Developing Brain, Division of Imaging Science & Biomedical Engineering, King's College London, London, UK
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands.
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95
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Webbe JWH, Duffy JMN, Afonso E, Al-Muzaffar I, Brunton G, Greenough A, Hall NJ, Knight M, Latour JM, Lee-Davey C, Marlow N, Noakes L, Nycyk J, Richard-Löndt A, Wills-Eve B, Modi N, Gale C. Core outcomes in neonatology: development of a core outcome set for neonatal research. Arch Dis Child Fetal Neonatal Ed 2020; 105:425-431. [PMID: 31732683 PMCID: PMC7363790 DOI: 10.1136/archdischild-2019-317501] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/01/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neonatal research evaluates many different outcomes using multiple measures. This can prevent synthesis of trial results in meta-analyses, and selected outcomes may not be relevant to former patients, parents and health professionals. OBJECTIVE To define a core outcome set (COS) for research involving infants receiving neonatal care in a high-income setting. DESIGN Outcomes reported in neonatal trials and qualitative studies were systematically reviewed. Stakeholders were recruited for a three-round international Delphi survey. A consensus meeting was held to confirm the final COS, based on the survey results. PARTICIPANTS Four hundred and fourteen former patients, parents, healthcare professionals and researchers took part in the eDelphi survey; 173 completed all three rounds. Sixteen stakeholders participated in the consensus meeting. RESULTS The literature reviews identified 104 outcomes; these were included in round 1. Participants proposed 10 additional outcomes; 114 outcomes were scored in rounds 2 and 3. Round 1 scores showed different stakeholder groups prioritised contrasting outcomes. Twelve outcomes were included in the final COS: survival, sepsis, necrotising enterocolitis, brain injury on imaging, general gross motor ability, general cognitive ability, quality of life, adverse events, visual impairment/blindness, hearing impairment/deafness, retinopathy of prematurity and chronic lung disease/bronchopulmonary dysplasia. CONCLUSIONS AND RELEVANCE A COS for clinical trials and other research studies involving infants receiving neonatal care in a high-income setting has been identified. This COS for neonatology will help standardise outcome selection in clinical trials and ensure these are relevant to those most affected by neonatal care.
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Affiliation(s)
| | - James M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Elsa Afonso
- Neonatal Unit, Rosie Hospital, Cambridge, Cambridgeshire, UK
| | - Iyad Al-Muzaffar
- The Neonatal Unit, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK
| | - Ginny Brunton
- UCL Institute of Education Centre for Longitudinal Studies, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nigel J Hall
- Paediatric Surgery, Southampton General Hospital, Southampton, UK
| | | | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, Education and Society, Plymouth University, Plymouth, Devon, UK
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | | | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | | | - Julie Nycyk
- Neonatal Unit, Birmingham City Hospital, Birmingham, UK
| | | | | | - Neena Modi
- Neonatal Medicine, Imperial College London, London, UK
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
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96
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Prediction of mortality in premature neonates. An updated systematic review. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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97
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Helenius K, Morisaki N, Kusuda S, Shah PS, Norman M, Lehtonen L, Reichman B, Darlow BA, Noguchi A, Adams M, Bassler D, Håkansson S, Isayama T, Berti E, Lee SK, Vento M, Lui K. Survey shows marked variations in approaches to redirection of care for critically ill very preterm infants in 11 countries. Acta Paediatr 2020; 109:1338-1345. [PMID: 31630444 DOI: 10.1111/apa.15069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 01/27/2023]
Abstract
AIM We surveyed care practices for critically ill very preterm infants admitted to neonatal intensive care units (NICUs) in the International Network for Evaluating Outcomes in Neonates (iNeo) to identify differences relevant to outcome comparisons. METHODS We conducted an online survey on care practices for critically ill very preterm infants and infants with severe intracranial haemorrhage (ICH). The survey was distributed in 2015 to representatives of 390 NICUs in 11 countries. Survey replies were compared with network incidence of death and severe ICH for infants born between 230/7 and 286/7 weeks of gestation from January 1, 2015, to December 31, 2015. RESULTS Most units in Israel, Japan and Tuscany, Italy, favoured withholding care when care was considered futile, whereas most units in other networks favoured redirection of care. For infants with bilateral grade 4 ICH, redirection of care was very frequently (≥90% of cases) offered in the majority of units in Australia and New Zealand and Switzerland, but rarely in other networks. Networks where redirection of care was frequently offered for severe ICH had lower rates of survivors with severe ICH. CONCLUSION We identified marked inter-network differences in care approaches that need to be considered when comparing outcomes.
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Affiliation(s)
- Kjell Helenius
- Department of Paediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Naho Morisaki
- Department of Social Medicine Neonatal Research Network Japan National Center for Child Health and Development Tokyo Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan Maternal and Perinatal Center Tokyo Women's Medical University Tokyo Japan
| | - Prakesh S. Shah
- Department of Paediatrics Mount Sinai Hospital and University of Toronto Toronto Canada
- Maternal‐Infant Care Research Centre Mount Sinai Hospital Toronto Canada
| | - Mikael Norman
- Department of Neonatal Medicine Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Centre Tel Hashomer Israel
| | - Brian A. Darlow
- Department of Paediatrics University of Otago Christchurch New Zealand
| | | | - Mark Adams
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Dirk Bassler
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics Umeå University Hospital Umeå Sweden
| | - Tetsuya Isayama
- Division of Neonatology National Center for Child Health and Development Tokyo Japan
| | - Elettra Berti
- Neonatal Intensive Care Unit Anna Meyer Children’s University Hospital Florence Italy
| | - Shoo K. Lee
- Department of Paediatrics Mount Sinai Hospital and University of Toronto Toronto Canada
- Maternal‐Infant Care Research Centre Mount Sinai Hospital Toronto Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health University of Toronto Toronto Canada
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe Valencia Spain
| | - Kei Lui
- Royal Hospital for Women National Perinatal Epidemiology and Statistic Unit University of New South Wales Randwick NSW Australia
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Lebreton E, Crenn-Hebert C, Menguy C, Howell EA, Gould JB, Dechartres A, Zeitlin J. Composite neonatal morbidity indicators using hospital discharge data: A systematic review. Paediatr Perinat Epidemiol 2020; 34:350-365. [PMID: 32207172 PMCID: PMC7418783 DOI: 10.1111/ppe.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/13/2020] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research. OBJECTIVES To inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data. DATA SOURCES PubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data." STUDY SELECTION AND DATA EXTRACTION Studies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted. SYNTHESIS For each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite. RESULTS Seventeen studies fulfilled inclusion criteria. Indicators targeted all (n = 4), low-/moderate-risk (n = 9), and very preterm (VPT, n = 4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/moderate-risk infants, and 17.8% to 61.0% of VPT infants. CONCLUSIONS Multiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results.
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Affiliation(s)
- Elodie Lebreton
- Data Science and Analytics Department, SESAN, Paris, France,Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France
| | - Catherine Crenn-Hebert
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France,Maternity unit, Louis Mourier University Hospital, APHP, Colombes, France
| | - Claudie Menguy
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Paris, France,Department of Medical Information, André Grégoire Hospital, Montreuil, France
| | - Elizabeth A. Howell
- Women’s Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, and Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey B. Gould
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Agnès Dechartres
- Sorbonne Université, Inserm U1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département Biostatistique, santé publique, information médicale - Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, F-75004 Paris, France
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Isayama T, Kusuda S, Reichman B, Lee SK, Lehtonen L, Norman M, Adams M, Bassler D, Helenius K, Hakansson S, Yang J, Jain A, Shah PS. Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm. J Pediatr 2020; 220:34-39.e5. [PMID: 32145968 DOI: 10.1016/j.jpeds.2020.01.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/07/2020] [Accepted: 01/31/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess associations between neonatal intensive care unit (NICU)-level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes. STUDY DESIGN This cohort study included infants born at 24-28 weeks of gestation and birth weight <1500 g in 2007-2015 in NICUs caring for ≥100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio. RESULTS From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P<.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis. CONCLUSIONS Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospita, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospita, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Stellan Hakansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Junmin Yang
- Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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100
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Del Río R, Thió M, Bosio M, Figueras J, Iriondo M. [Prediction of mortality in premature neonates. An updated systematic review]. An Pediatr (Barc) 2020; 93:24-33. [PMID: 31926888 DOI: 10.1016/j.anpedi.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/13/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Extreme prematurity is associated with high mortality rates. The probability of death at different points in time is a priority for professionals and parents, and needs to be established on an individual basis. The aim of this study is to carry out a systematic review of predictive models of mortality in premature infants that have been published recently. METHODS A double search was performed for article published in PubMed on models predicting mortality in premature neonates. The population studied were premature neonates with a gestational age of ≤30 weeks and / or a weight at birth of ≤1500g. Works published with new models from June 2010 to July 2019 after a systematic review by Medlock (2011) were included. An assessment was made of the population, characteristics of the model, variables used, measurements of functioning, and validation. RESULTS Of the 7744 references (1st search) and 1435 (2nd search) found, 31 works were selected, with 8 new models finally being included. Five models (62.5%) were developed in North America and 2 (25%) in Europe. A sequential model (Ambalavanan) enables predictions of mortality to be made at birth, 7, 28 days of life, and 36 weeks post-menstrual. A multiple logistic regression analysis was performed on 87.5% of the models. The population discrimination was measured using Odds Ratio (75%) and the area under the curve (50%). "Internal Validation" had been carried out on 5 models. Three models can be accessed on-line. There are no predictive models validated in Spain. CONCLUSIONS The making of decisions based on predictive models can lead to the care given to the premature infant being more individualised and with a better use of resources. Predictive models of mortality in premature neonates in Spain need to be developed.
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Affiliation(s)
- Ruth Del Río
- Departamento de Neonatología, Hospital Sant Joan de Déu, BCNatal-Hospital Clínic-Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España.
| | - Marta Thió
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, University of Melbourne, Melbourne, Australia
| | - Mattia Bosio
- Barcelona Supercomputing Center (BSC), Barcelona, España
| | - Josep Figueras
- Departamento de Neonatología, Hospital Clínic, BCNatal-Hospital Clínic-Hospital Sant Joan de Déu, Universitat de Barcelona, España
| | - Martín Iriondo
- Departamento de Neonatología, Hospital Sant Joan de Déu, BCNatal-Hospital Clínic-Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España
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