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Mizuno K, Takeuchi M, Kishimoto Y, Kawakami K, Omori K. Indications and outcomes of paediatric tracheotomy: a descriptive study using a Japanese claims database. BMJ Open 2019; 9:e031816. [PMID: 31852701 PMCID: PMC6937105 DOI: 10.1136/bmjopen-2019-031816] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the incidence of and indications for paediatric tracheotomy to clarify the disease burden relevant to tracheotomy in a population-based context. DESIGN A descriptive analysis of a retrospective cohort. SETTING This study utilised a nationwide claims database in Japan constructed by JMDC (Tokyo, Japan). The database includes claims data for approximately 3.75 million insured persons (approximately 3.1% of the population of Japan) comprising mainly company employees and their family members. PARTICIPANTS We identified children registered to have undergone tracheotomy from 2005 to 2017 among about 1.2 million children aged 0-15 years. MAIN OUTCOME MEASURES The characteristics of the study population, and indications for tracheotomy, duration of hospital stay, duration of mechanical ventilation, duration of tracheotomy dependence, complications related to tracheotomy and death were assessed. When there were multiple indications, classification for a child into multiple groups was allowed. RESULTS The study included 215 children (120 males, 56%). The median age at tracheotomy was 0.8 years. The most common age at tracheotomy was less than 12 months (n=127, 59.1%). The most common indications for tracheotomy were chronic lung disease (n=79, 36.7%), followed by neuromuscular disease (n=77, 35.8%), cardiovascular disease (n=53, 24.3%), upper airway obstruction (n=43, 20%), premature birth and related conditions (n=34, 15.8%), trauma (n=16, 7.4%), prolonged ventilation due to other causes (n=12, 5.6%) and malignancy (n=9, 4.2%). The median duration of tracheotomy dependence was 17.2 months. During the follow-up period, decannulation was achieved in 84 children (39.1%), and the median time from tracheotomy to decannulation was 12.0 months. CONCLUSIONS Most paediatric tracheotomies were performed due to chronic underlying diseases, and the mean duration of tracheotomy dependence was nearly 1-½ years. The long-term duration of tracheotomy dependence might have some impacts on patients' physical and mental development and the quality of life.
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Affiliation(s)
- Kayoko Mizuno
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine Department of Public Health, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine Department of Public Health, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine Department of Public Health, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
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Lui K, Lee SK, Kusuda S, Adams M, Vento M, Reichman B, Darlow BA, Lehtonen L, Modi N, Norman M, Håkansson S, Bassler D, Rusconi F, Lodha A, Yang J, Shah PS. Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries. J Pediatr 2019; 215:32-40.e14. [PMID: 31587861 DOI: 10.1016/j.jpeds.2019.08.020] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/04/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. STUDY DESIGN In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 240/7 to 316/7 weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. RESULTS For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. CONCLUSIONS In most countries, mortality decreased whereas BPD increased for neonates born very preterm.
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Affiliation(s)
- 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, NSW, Australia
| | - Shoo K Lee
- Department of Pediatrics, Sinai Health System, University of Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Satoshi Kusuda
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Franca Rusconi
- Unit of Epidemiology Meyer Children's University Hospital and Regional Health Agency, Florence, Italy
| | - Abhay Lodha
- Pediatrics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Sinai Health System, University of Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada
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103
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Abstract
In the absence of effective interventions to prevent preterm births, improved survival of infants who are born at the biological limits of viability has relied on advances in perinatal care over the past 50 years. Except for extremely preterm infants with suboptimal perinatal care or major antenatal events that cause severe respiratory failure at birth, most extremely preterm infants now survive, but they often develop chronic lung dysfunction termed bronchopulmonary dysplasia (BPD; also known as chronic lung disease). Despite major efforts to minimize injurious but often life-saving postnatal interventions (such as oxygen, mechanical ventilation and corticosteroids), BPD remains the most frequent complication of extreme preterm birth. BPD is now recognized as the result of an aberrant reparative response to both antenatal injury and repetitive postnatal injury to the developing lungs. Consequently, lung development is markedly impaired, which leads to persistent airway and pulmonary vascular disease that can affect adult lung function. Greater insights into the pathobiology of BPD will provide a better understanding of disease mechanisms and lung repair and regeneration, which will enable the discovery of novel therapeutic targets. In parallel, clinical and translational studies that improve the classification of disease phenotypes and enable early identification of at-risk preterm infants should improve trial design and individualized care to enhance outcomes in preterm infants.
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104
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Abstract
With current screening for sight threatening retinopathy of prematurity (ROP) <10% of screened infants need treatment. Prediction models based on birth characteristics, postnatal weight gain and other factors have been developed to reduce examinations in low-risk infants. A model based on advanced statistics using data from >7000 infants registered in the Swedish ROP registry is being developed. Based on birth characteristics only, it appears to predict total risk of ROP-treatment as well as models including weight measurements. Treatment risk peaked at 12 weeks of age. Laser therapy is the method of choice for severe ROP. Anti-VEGF therapies are implemented worldwide despite insufficient knowledge of choice of drug, dosage and long term systemic effects. Prevention of ROP may be achieved through oxygen control and provision of the mother's breastmilk. Other interventions such as supplementation with long chain polyunsaturated fatty acids and preservation of fetal haemoglobin are investigated.
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105
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Choi J, Urubuto F, Dusabimana R, Agaba F, Teteli R, Kumwami M, O'Callahan C, Cartledge PT. Establishing a neonatal database in a tertiary hospital in Rwanda - an observational study. Paediatr Int Child Health 2019; 39:265-274. [PMID: 31079590 DOI: 10.1080/20469047.2019.1607056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Monitoring and evaluation is vital in the quest to improve the quality of care and to reduce the morbidity and mortality of neonates in a resource-limited setting. Databases offer several advantages such as data on large cohorts of neonates and from multiple centres. Aim: To establish a minimal dataset neonatal database in Kigali, Rwanda and to assess the quality and timing of the data entry process. Secondary objectives were to describe survival rates and associated risk factors. Methods: A cross-sectional, observational study was undertaken at a tertiary hospital in Kigali, Rwanda. The Rwanda Neonatal Data Collection Form was designed specifically for the database, based on the Vermont-Oxford Network neonatal data-collection tool with locally relevant amendments. All admitted neonates were enrolled during the study period of 2011-2017 with ongoing data-collection. Infants were recruited and data collected prospectively and cross-checked retrospectively with the inclusion of basic data on neonates who were not initially recruited prospectively. Results: 3391 analysable cases were recruited: 1420 prospective and 1971 retrospective cases. Prospective data collection peaked at 90%. Data entry was not always complete with data-points left blank with only 21% having adequate data available (0-25% missing). All-cause mortality during the study period was 16% and annual mortality ranged from 12% to 24%. On multivariate analysis, place of birth (AOR 2.17), small-for-gestational-age (AOR 2.05) and gestational age were all positively associated with survival. Conclusions: An academic setting in a low- or middle-income country can create and maintain a neonatal database without funding and produce a wealth of actionable results. Throughout the process, there were considerable challenges which must be addressed if such a database is to be optimised, maintained and created in other clinical sites. Abbreviations: CHUK: Centre Hospitalier et Universitaire de Kigali (University Teaching Hospital of Kigali); CPAP: continuous positive airway pressure; HCP: Healthcare professional; HRH, Human Resources for Health Programme; LMIC: low- and middle-income countries; MeSH: Medical subject headings; MoH: Ministry of Health; NAR: Newborn admission record; QI: Quality improvement; REDCap: Research electronic data capture; RNDB: Rwanda neonatal database; RNDCF: Rwanda neonatal data collecion form; SGA: Small for gestational age; STROBE: Strengthening the reporting of observational studies in epidemiology; VON: The Vermont-Oxford Network.
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Affiliation(s)
- Jaeseok Choi
- Department of Paediatrics, University of Rwanda , Kigali , Rwanda.,Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Fedine Urubuto
- Department of Paediatrics, University of Rwanda , Kigali , Rwanda.,Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Raban Dusabimana
- Department of Paediatrics, University of Rwanda , Kigali , Rwanda.,Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Faustine Agaba
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Raissa Teteli
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda.,Department of Paediatrics, Harmony Private Clinic , Kigali , Rwanda
| | - Muzungu Kumwami
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Cliff O'Callahan
- Department of Paediatrics, Middlesex Hospital and University of Connecticut , Connecticut , USA
| | - Peter Thomas Cartledge
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda.,USA and Department of Paediatrics, Rwanda Human Resources for Health (HRH) Program, Yale University , Kigali , Rwanda
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106
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Khanafer-Larocque I, Soraisham A, Stritzke A, Al Awad E, Thomas S, Murthy P, Kamaluddeen M, Scott JN, Mohammad K. Intraventricular Hemorrhage: Risk Factors and Association With Patent Ductus Arteriosus Treatment in Extremely Preterm Neonates. Front Pediatr 2019; 7:408. [PMID: 31696098 PMCID: PMC6817605 DOI: 10.3389/fped.2019.00408] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 09/20/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives: To assess maternal and neonatal risk factors for intraventricular hemorrhage (IVH). To examine the association of patent ductus arteriosus (PDA) and its treatment, with IVH and its severity. Study design: In this retrospective cohort study, we included preterm neonates born at <29 weeks, admitted to a tertiary level III Neonatal Intensive Care Unit in Calgary, Canada, between 2013 and 2016, who had a head ultrasound in the first 7 days of life. A subset analysis included neonates who also had cardiac ultrasound in the first 3 days of life. Results: Of the 495 neonates, 121 (24.4%) had IVH of any grade and 48 (9.7%) had severe IVH. Identified risk factors were small birth gestation and weight, lack of antenatal corticosteroids, maternal chorioamnionitis, Apgar score <5 at 5 min, umbilical cord pH < 7, respiratory distress syndrome, early onset sepsis, hypercapnia, pCO2 fluctuations, prolonged intubation, inhaled nitric oxide, inotropes or normal saline boluses, metabolic derangements, opioids infusions, and bicarbonate/THAM therapy. In a primary analysis of the total cohort, when the decision to treat a PDA was used as a surrogate marker of its clinical significance, a PDA requiring treatment was associated with a higher risk of IVH. There was no significant difference in the incidence of IVH between neonates with early treatment of a clinically significant PDA compared to late, however early indomethacin treatment was associated with reduced severity of IVH. In the subset analysis, the presence of a hemodynamically significant PDA (hs-PDA) was not associated with a higher probability of IVH. Of those with severe IVH, 18 (55%) had a hs-PDA; this is clinically but not statistically significant. Conclusions: Identified risk factors should be the target of IVH reduction bundles. Early indomethacin treatment for a clinically significant PDA may reduce IVH severity.
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Affiliation(s)
- Ijab Khanafer-Larocque
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Section of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Amuchou Soraisham
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Amelie Stritzke
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Essa Al Awad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sumesh Thomas
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Prashanth Murthy
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Majeeda Kamaluddeen
- Section of Neonatology, 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
| | - Khorshid Mohammad
- Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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107
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Adams M, Bassler D, Darlow BA, Lui K, Reichman B, Hakansson S, Norman M, Lee SK, Helenius KK, Lehtonen L, San Feliciano L, Vento M, Moroni M, Beltempo M, Yang J, Shah PS. Preventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis. BMJ Open 2019; 9:e031086. [PMID: 31615799 PMCID: PMC6797308 DOI: 10.1136/bmjopen-2019-031086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To compare necrotising enterocolitis (NEC) prevention practices and NEC associated factors between units from eight countries of the International Network for Evaluation of Outcomes of Neonates, and to assess their association with surgical NEC rates. DESIGN Prospective unit-level survey combined with retrospective cohort study. SETTING Neonatal intensive care units in Australia/New Zealand, Canada, Finland, Israel, Spain, Sweden, Switzerland and Tuscany (Italy). PATIENTS Extremely preterm infants born between 240 to 286 weeks' gestation, with birth weights<1500 g, and admitted between 2014-2015. EXPOSURES NEC prevention practices (probiotics, feeding, donor milk) using responses of an on-line pre-piloted questionnaire containing 10 questions and factors associated with NEC in literature (antenatal steroids, c-section, indomethacin treated patent ductus arteriosus and sepsis) using cohort data. OUTCOME MEASURES Surgical NEC rates and death following NEC using cohort data. RESULTS The survey response rate was 91% (153 units). Both probiotic provision and donor milk availability varied between 0%-100% among networks whereas feeding initiation and advancement rates were similar in most networks. The 9792 infants included in the cohort study to link survey results and cohort outcomes, revealed similar baseline characteristics but considerable differences in factors associated with NEC between networks. 397 (4.1%) neonates underwent NEC surgery, ranging from 2.4%-8.4% between networks. Standardised ratios for surgical NEC were lower for Australia/New Zealand, higher for Spain, and comparable for the remaining six networks. CONCLUSIONS The variation in implementation of NEC prevention practices and in factors associated with NEC in literature could not be associated with the variation in surgical NEC incidence. This corroborates the current lack of consensus surrounding the use of preventive strategies for NEC and emphasises the need for research.
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MESH Headings
- Cause of Death
- Cohort Studies
- Data Analysis
- Databases, Factual
- Enterocolitis, Necrotizing/mortality
- Enterocolitis, Necrotizing/prevention & control
- Enterocolitis, Necrotizing/surgery
- Female
- Hospital Mortality/trends
- Humans
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/surgery
- Intensive Care Units, Neonatal
- Internationality
- Male
- Primary Prevention/methods
- Probiotics/administration & dosage
- Prognosis
- Retrospective Studies
- Risk Factors
- Surveys and Questionnaires
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Mark Adams
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Otago, New Zealand
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - Stellan Hakansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Shoo K Lee
- Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Kjell K Helenius
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, University of Turku, Turku, Finland
| | | | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, University of Valencia, Valencia, Spain
| | - Marco Moroni
- Neonatal Intensive Care Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - Junmin Yang
- Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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108
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Sasaki Y, Ishikawa K, Yokoi A, Ikeda T, Sengoku K, Kusuda S, Fujimura M. Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status. Pediatr Crit Care Med 2019; 20:963-969. [PMID: 31232855 PMCID: PMC6784765 DOI: 10.1097/pcc.0000000000002037] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Outborn (born outside tertiary centers) infants, especially extremely preterm infants, are at an increased risk of mortality and morbidity in comparison to inborn (born in tertiary centers) infants. Extremely preterm infants require not only skilled neonatal healthcare providers but also highly specialized equipment and environment surroundings. Maternal transport at an appropriate timing must be done to avoid the delivery of extremely preterm infants in a facility without the necessary capabilities. Cases of unexpected deliveries at birth centers or level I maternity hospitals need to be attended emergently. We compared the differences in short- and long-term outcomes between outborn and inborn infants to improve our regional perinatal system. DESIGN Retrospective cohort study. SETTING Neonatal Research Network of Japan database. PATIENTS Extremely preterm infants (gestational age between 22 + 0 and 27 + 6 wk) in the Neonatal Research Network of Japan database between 2003 and 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 12,164 extremely preterm infants, who were divided into outborn (n = 785, 6.5%) and inborn (n = 11,379, 93.5%) groups, were analyzed. Significant differences were observed in demographic and clinical factors between the two groups. Outborn infants had higher short-term odds of severe intraventricular hemorrhage (adjusted odds ratio, 1.49; 95% CI, 1.11-2.00; p < 0.01), necrotizing enterocolitis (adjusted odds ratio, 1.49; 95% CI, 1.11-2.00; p < 0.01), and focal intestinal perforation (adjusted odds ratio, 1.58; 95% CI, 1.09-2.30; p = 0.02). There were no significant differences in long-term outcomes between the two groups, except in the rate of cognitive impairment (adjusted odds ratio, 1.49; 95% CI, 1.01-2.20; p = 0.04). CONCLUSIONS The frequency of severe intraventricular hemorrhage, necrotizing enterocolitis or focal intestinal perforation, and cognitive impairment was significantly higher in outborn infants. Thus, outborn/inborn birth status may play a role in short- and long-term outcomes of extremely preterm infants. However, more data and evaluation of improvement in the current perinatal environment are needed.
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Affiliation(s)
- Yoshihito Sasaki
- Department of Obstetrics and Neonatology, Funabashi Central Hospital, Funabashi, Japan
| | | | - Akira Yokoi
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - Kazuo Sengoku
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
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109
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Kiechl‐Kohlendorfer U, Simma B, Urlesberger B, Maurer‐Fellbaum U, Wald M, Wald M, Weissensteiner M, Ehringer‐Schetitska D, Berger A, Kurz H, Bernert G, Frischer T, Minkov M, Zwiauer K, Salzer H, Falger J, Jaros Z, Peter Wagentristl H, Bruckne R, Birnbacher R, Kaulfersch W, Wiesinger‐Eidenberger G, Riedler J. Low mortality and short-term morbidity in very preterm infants in Austria 2011-2016. Acta Paediatr 2019; 108:1419-1426. [PMID: 30817025 PMCID: PMC6767187 DOI: 10.1111/apa.14767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/24/2019] [Accepted: 02/26/2019] [Indexed: 01/03/2023]
Abstract
AIM The current study determined survival, short-term neonatal morbidity and predictors for death or adverse outcome of very preterm infants in Austria. METHODS This population-based cohort study included 5197 very preterm infants (53.3% boys) born between 2011 and 2016 recruited from the Austrian Preterm Outcome Registry. Main outcome measures were gestational age-related mortality and major short-term morbidities. RESULTS Overall, survival rate of all live-born infants included was 91.6% and ranged from 47.1% and 73.4% among those born at 23 and 24 weeks of gestation to 84.9% and 88.2% among infants born at 25 and 26 weeks to more than 90.0% among those with a gestational age of 27 weeks or more. The overall prevalence of chronic lung disease, necrotising enterocolitis requiring surgery, intraventricular haemorrhage Grades 3-4, and retinopathy of prematurity Grades 3-5 was 10.0%, 2.1%, 5.5%, and 3.6%, respectively. Low gestational age, low birth weight, missing or incomplete course of antenatal steroids, male sex, and multiple births were significant risk predictors for death or adverse short-term outcome. CONCLUSION In this national cohort study, overall survival rates were high and short-term morbidity rate was low.
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Affiliation(s)
- U Kiechl‐Kohlendorfer
- Department of Paediatrics II (Neonatology) Medical University of Innsbruck Innsbruck Austria
| | - B Simma
- Department of Paediatrics Academic Teaching Hospital Landeskrankenhaus Feldkirch Feldkirch Austria
| | - B Urlesberger
- Department of Paediatrics Division of Neonatology Medical University of Graz Graz Austria
| | - U Maurer‐Fellbaum
- Department of Paediatrics Division of Neonatology Medical University of Graz Graz Austria
| | - M Wald
- Division of Neonatology Paracelsus Medical University Salzburg Salzburg Austria
| | - M Wald
- Department of Paediatrics Klinikum Wels‐Grieskirchen Wels Austria
| | - M Weissensteiner
- Department of Paediatrics Kepler University Hospital Linz Austria
| | | | - A Berger
- Department of Paediatrics and Adolescent Medicine Division of Neonatology Paediatric Intensive Care and Neuropaediatrics Medical University of Vienna Vienna Austria
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Shah PS, Lehtonen L. Net worth of networks: opportunities and potential. Acta Paediatr 2019; 108:1374-1376. [PMID: 31099026 DOI: 10.1111/apa.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Prakesh S. Shah
- Department of Paediatrics and Maternal‐Infant Care Research Centre Mount Sinai Hospital Toronto Ontario Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine Turku University Hospital Turku Finland
- Department of Clinical Medicine University of Turku Turku Finland
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Isayama T. The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future. Transl Pediatr 2019; 8:199-211. [PMID: 31413954 PMCID: PMC6675688 DOI: 10.21037/tp.2019.07.10] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is a wide variation in neonatal mortality rates across regions and countries. Japan has one of the lowest neonatal mortality rates in the world; in particular, the mortality rate of extremely preterm infants (i.e., those born before 26 weeks of gestation) is much lower in Japan than in other developed countries. In addition, Japan has low incidences of intraventricular hemorrhage, necrotizing enterocolitis, and late-onset sepsis, a very high incidence of retinopathy of prematurity, and a relatively high incidence of chronic lung disease. In Japan, general perinatal medical centers (PMCs), which are PMCs that offer the highest levels of care, are required to have an obstetric department with maternal-fetal intensive care units as well as a neonatal or pediatric department with neonatal intensive care units (NICU), in order to promote antenatal rather than neonatal maternal transfer of high-risk cases. The limit of viability of extremely preterm infants is 22 weeks of gestation, and approximately half of them are estimated to receive active resuscitation. The clinical management of extremely preterm infants in Japan are characterized by (I) circulatory management that is guided by neonatologist-performed echocardiography, (II) relatively invasive respiratory management, (III) nutritional management, which entails the promotion of breast milk feeding, early enteral feeding, routine glycerin enema, and the administration of probiotics, (IV) neurological management by means of minimal handling, sedation of ventilated infants, and serial brain ultrasounds, and (V) infection control with the assistance of serial C-reactive protein (CRP) monitoring. Thus, this review provides a brief description of the development of neonatology in Japan, introduces the unique features of Japanese clinical management of extremely preterm infants, and overviews their outcomes.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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112
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Spotswood N, Orsini F, Dargaville P. Association of Center-Specific Patient Volumes and Early Respiratory Management Practices with Death and Bronchopulmonary Dysplasia in Preterm Infants. J Pediatr 2019; 210:63-68.e2. [PMID: 31005279 DOI: 10.1016/j.jpeds.2019.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/05/2019] [Accepted: 02/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe variability in admission volumes and approach to early respiratory support between neonatal intensive care units in the Australian and New Zealand Neonatal Network and to evaluate whether these center-specific factors are associated with death and bronchopulmonary dysplasia. STUDY DESIGN This retrospective cohort study included 19 099 neonates born between 25 and 32 weeks' gestation and admitted to 1 of 25 NICUs from 2007 to 2013. Center-specific factors evaluated were annual admission volume and rate of using continuous positive airway pressure (CPAP) rather than intubation as the first mode of respiratory support. Logistic regression was used to examine any association of these center-specific factors with death, BPD, and death or survival with BPD (death/BPD). Analysis was performed separately for 2 gestation groups (25-28 weeks and 29-32 weeks inclusive). RESULTS Admission volumes and rates of early CPAP use varied widely across centers. Higher admission volumes were associated with lower odds of death or survival with BPD in the 25-28 week group (aOR 0.93, 99% CI 0.88-0.99 per increase of 10 babies per center annually). Centers with higher early CPAP use did not have lower odds of death or BPD than centers that intubated more frequently. CONCLUSIONS Higher admission volumes are associated with more favorable outcomes for the more preterm infants in the Australian and New Zealand Neonatal Network. Further investigation is required to explore why the individual benefits of early CPAP do not translate to better outcomes for centers that use this approach most frequently.
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Affiliation(s)
- Naomi Spotswood
- Department of Pediatrics, Royal Hobart Hospital, Hobart, Australia; Burnet Institute, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Trials Center, Murdoch Children's Research Institute, Melbourne, Australia
| | - Peter Dargaville
- Department of Pediatrics, Royal Hobart Hospital, Hobart, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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113
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Shah PS, Lui K, Reichman B, Norman M, Kusuda S, Lehtonen L, Adams M, Vento M, Darlow BA, Modi N, Rusconi F, Håkansson S, San Feliciano L, Helenius KK, Bassler D, Hirano S, Lee SK. The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities. Transl Pediatr 2019; 8:170-181. [PMID: 31413951 PMCID: PMC6675683 DOI: 10.21037/tp.2019.07.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 01/15/2023] Open
Abstract
Neonates born very preterm (before 32 weeks' gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.
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Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - 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
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, UK
| | - Franca Rusconi
- Neonatal Intensive Care Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | | | - Kjell K Helenius
- Department of Pediatrics 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
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Modi N. Information technology infrastructure, quality improvement and research: the UK National Neonatal Research Database. Transl Pediatr 2019; 8:193-198. [PMID: 31413953 PMCID: PMC6675679 DOI: 10.21037/tp.2019.07.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Technological developments, coupled with strengthened governance and data security have led to increasing recognition of the potential of real-world health data to benefit patient care and health services. Real-world health data are those captured in the course of routine care. Here I describe a mature source of real-world health data, the UK National Neonatal Research Database and provide examples of the many types of uses it supports.
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Affiliation(s)
- Neena Modi
- Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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115
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Sai Kiranmayee P, Kalluri V. India to gear up to the challenge of "third epidemic" of retinopathy of prematurity in the world. Indian J Ophthalmol 2019; 67:726-731. [PMID: 31124480 PMCID: PMC6552629 DOI: 10.4103/ijo.ijo_700_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 02/19/2019] [Indexed: 12/13/2022] Open
Abstract
Many of the causes of childhood blindness are avoidable, being either preventable or treatable. Retinopathy of prematurity (ROP) remains one of the most preventable causes of childhood blindness worldwide. Currently, India is facing the third epidemic of ROP. In India, the health system involving the mother and child health services needs to be strengthened with a policy to cover the existing inadequacies in neonatal care and implementation of program covering newborn, especially premature. The access, availability, and affordability of services related to the care of premature babies need strengthening in India. ROP-trained ophthalmologists and neonatal care pediatricians and a professional togetherness is a big issue. Inadequacies in awareness of ROP among the parents, health care workers, counsellors add up to the problem. Community-based health workers such as Accredited Social Health Activist are a good dependable force in India and are needed to be trained in awareness and establishing a proper identification for prompt referral. ROP prevention needs a multidisciplinary team approach. ROP management stands as a good example of all the strategies for prevention, which includes primary prevention (improving obstetric and neonatal care), secondary prevention (screening and treatment programs), and tertiary prevention (treating complications and rehabilitation to reduce disability). Given its demographic and cultural diversity, India faces numerous challenges, with significant rural-urban, poor-rich, gender, socioeconomic, and regional differences. So, we need to gear up to face the present challenge of the third epidemic of ROP and prevent ROP-related childhood blindness as it is the need of the hour.
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Affiliation(s)
- P Sai Kiranmayee
- Department of Vitreo-Retinal Services, Pushpagiri Vitreo-Retinal Institute, West Marredpally, Secunderabad, Telangana, India
| | - Viswanath Kalluri
- Department of Vitreo-Retinal Services, Pushpagiri Vitreo-Retinal Institute, West Marredpally, Secunderabad, Telangana, India
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Challis P, Larsson L, Stoltz Sjöström E, Serenius F, Domellöf M, Elfvin A. Validation of the diagnosis of necrotising enterocolitis in a Swedish population-based observational study. Acta Paediatr 2019; 108:835-841. [PMID: 30238614 PMCID: PMC6586065 DOI: 10.1111/apa.14585] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022]
Abstract
Aim The definition of necrotising enterocolitis (NEC) is based on clinical and radiological signs that can be difficult to interpret. The aim of the present study was to validate the incidence of NEC in the Extremely Preterm Infants in Sweden Study (EXPRESS) Methods The EXPRESS study consisted of all 707 infants born before 27 + 0 gestational weeks during the years 2004–2007 in Sweden. Of these infants, 38 were recorded as having NEC of Bell stage II or higher. Hospital records were obtained for these infants. Furthermore, to identify missed cases, all infants with a sudden reduction of enteral nutrition, in the EXPRESS study were identified (n = 71). Hospital records for these infants were obtained. Thus, 108 hospital records were obtained and scored independently by two neonatologists for NEC. Results Of 38 NEC cases in the EXPRESS study, 26 were classified as NEC after validation. Four cases not recorded in the EXPRESS study were found. The incidence of NEC decreased from 6.3% to 4.3%. Conclusion Validation of the incidence of NEC revealed over‐ and underestimation of NEC in the EXPRESS study despite carefully collected data. Similar problems may occur in other national data sets or quality registers.
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Affiliation(s)
- Pontus Challis
- Department of Clinical Sciences Paediatrics Umeå University Umeå Sweden
| | - Linn Larsson
- Department of Clinical Sciences Paediatrics Umeå University Umeå Sweden
| | | | - Fredrik Serenius
- Department of Clinical Sciences Paediatrics Umeå University Umeå Sweden
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences Paediatrics Umeå University Umeå Sweden
| | - Anders Elfvin
- Institution of Clinical Sciences Department of Pediatrics Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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Early extubation is not associated with severe intraventricular hemorrhage in preterm infants born before 29 weeks of gestation. Results of an EPIPAGE-2 cohort study. PLoS One 2019; 14:e0214232. [PMID: 30946750 PMCID: PMC6448867 DOI: 10.1371/journal.pone.0214232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/09/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether there is an association between severe intraventricular hemorrhage and early extubation in preterm infants born before 29 weeks of gestational age and intubated at birth. Methods This study included 1587 preterm infants from a nationwide French population cohort (EPIPAGE-2). Secondary data on intubated preterm infants were analyzed. After gestational age and propensity score matching (1:1) we built two comparable groups: an early extubation group and a delayed extubation group. Each neonate in one group was paired with a neonate in the other group having the same propensity score and gestational age. Early extubation was defined as extubation within 48 hours of life. Severe intraventricular hemorrhages were defined as grade III or IV hemorrhages according to the Papile classification. Results After matching, there were 398 neonates in each group. Using a generalized estimating equation model, we found that intraventricular hemorrhage was not associated with early extubation (adjusted OR 0.9, 95%CI 0.6–1.4). This result was supported by sensitivity analyses. Conclusion The practice of early extubation was not associated with an increased proportion of intraventricular hemorrhages. To complete these results, the long-term neurologic outcomes of these infants need to be assessed.
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118
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Hoh JK, Lappas M, Liu C, Qiao C, Pallavi K, Takeda J, Kim YJ. Preterm birth rate and dilemma of preterm labor treatment in Asia. Placenta 2019; 79:68-71. [DOI: 10.1016/j.placenta.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/20/2018] [Accepted: 01/04/2019] [Indexed: 01/05/2023]
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Donda K, Vijayakanthi N, Dapaah-Siakwan F, Bhatt P, Rastogi D, Rastogi S. Trends in epidemiology and outcomes of respiratory distress syndrome in the United States. Pediatr Pulmonol 2019; 54:405-414. [PMID: 30663263 DOI: 10.1002/ppul.24241] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The management practices of Respiratory Distress Syndrome (RDS) in the newborn have changed over time. We examine the trends in the epidemiology, resource utilization, and outcomes (mortality and bronchopulmonary dysplasia [BPD]) of RDS in preterm neonates ≤34 weeks gestational age (GA) in the United States. METHODS In this retrospective serial cross-sectional study, we used ICD-9 codes to classify preterm infants GA ≤34 weeks between 2003 and 2014 from the National Inpatient Sample as having RDS or not. Trends in the prevalence of infants defined as RDS by ICD-9 code (ICD9-RDS), length of stay, BPD, and mortality were analyzed using Cochran-Armitage and Jonckheere-Terpstra tests and multivariable logistic regression. RESULTS Of 1 526 186 preterm live births with GA ≤34 weeks, 554 409 had ICD9-RDS (260 cases per 1000 live births) with the prevalence increasing from 170 to 361 (Ptrend < 0.001) and associated decrease in all-cause mortality (7.6% to 6.1%; Ptrend < 0.001) from 2003 to 2014. Increased utilization of non-invasive mechanical ventilation (NIMV) (69.5% to 74.3%; Ptrend < 0.001) was associated with decreased invasive mechanical ventilation (IMV) use >96 h (60.4 to 56.6%; Ptrend < 0.001). Exclusive NIMV use increased from 16.8% to 29.1% (Ptrend < 0.0001). BPD incidence decreased from 14% to 12.5% (Ptrend < 0.001). LOS increased from 32 days to 38 days (Ptrend < 0.001) and cost increased from $49,521 to $55,394 (Ptrend < 0.001). CONCLUSION From 2003 to 2014, the assigned ICD9-RDS diagnosis, and utilization of NIMV increased and mortality among infants assigned the ICD9-RDS diagnosis decreased. With higher survival, hospital cost increased incrementally, indicating the importance of ongoing analysis of appropriate reimbursement for the care provided at tertiary centers for preterm infants.
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Affiliation(s)
- Keyur Donda
- Department of Pediatrics, Division of Neonatology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nandini Vijayakanthi
- Division of Neonatology, Maimonides Infants and Children's Hospital, Brooklyn, New York
| | - Fredrick Dapaah-Siakwan
- Department of Pediatrics, Division of Neonatology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Parth Bhatt
- Department of Pediatrics, Texas Tech University Health Science Center, Amarillo, Texas
| | - Deepa Rastogi
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Shantanu Rastogi
- Division of Neonatology, Maimonides Infants and Children's Hospital, Brooklyn, New York
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Huang J, Zhang L, Tang J, Shi J, Qu Y, Xiong T, Mu D. Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2019; 104:F128-F136. [PMID: 29907614 DOI: 10.1136/archdischild-2017-314205] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants. DESIGN We searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study. RESULT A total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance. CONCLUSION Both exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.
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Affiliation(s)
- Jinglan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
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Joseph K. Towards a unified perinatal theory: Reconciling the births-based and fetus-at-risk models of perinatal mortality. Paediatr Perinat Epidemiol 2019; 33:101-112. [PMID: 30671994 PMCID: PMC6487839 DOI: 10.1111/ppe.12537] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a need to reconcile the opposing perspectives of the births-based and fetuses-at-risk models of perinatal mortality and to formulate a coherent and unified perinatal theory. METHODS Information on births in the United States from 2004 to 2015 was used to calculate gestational age-specific perinatal death rates for low- and high-risk cohorts. Cubic splines were fitted to the fetuses-at-risk birth and perinatal death rates, and first and second derivatives were estimated. Births-based perinatal death rates, and fetuses-at-risk birth and perinatal death rates and their derivatives, were examined to identify potential inter-relationships. RESULTS The rate of change in the birth rate dictated the pattern of births-based perinatal death rates in a triphasic manner: increases in the first derivative of the birth rate at early gestation corresponded with exponential declines in perinatal death rates, the peak in the first derivative presaged the nadir in perinatal death rates, and late gestation declines in the first derivative coincided with an upturn in perinatal death rates. Late gestation increases in the first derivative of the fetuses-at-risk perinatal death rate matched the upturn in births-based perinatal death rates. Differences in birth rate acceleration/deceleration among low- and high-risk cohorts resulted in intersecting perinatal mortality curves. CONCLUSION The first derivative of the birth rate links a cohort's fetuses-at-risk perinatal death rate to its births-based perinatal death rate, and cohort-specific differences in birth rate acceleration/deceleration are responsible for the intersecting perinatal mortality curves paradox. This mechanistic explanation unifies extant models of perinatal mortality and provides diverse insights.
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Affiliation(s)
- K.S. Joseph
- Department of Obstetrics and Gynaecology, School of Population and Public HealthUniversity of British Columbia and the Children’s and Women’s Hospital and Health Centre of British ColumbiaVancouverBritish ColumbiaCanada
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Lee JH, Noh OK, Chang YS. Neonatal Outcomes of Very Low Birth Weight Infants in Korean Neonatal Network from 2013 to 2016. J Korean Med Sci 2019; 34:e40. [PMID: 30718992 PMCID: PMC6356024 DOI: 10.3346/jkms.2019.34.e40] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/04/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. METHODS Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. RESULTS The survival rate of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22-23, 24-25, 26-27, 28-29, 30-32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24-27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. CONCLUSION Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22-27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.
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Affiliation(s)
- Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - O Kyu Noh
- Department of Radiation and Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
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Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns. Pediatr Res 2019; 85:312-317. [PMID: 30127523 DOI: 10.1038/s41390-018-0133-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/19/2018] [Accepted: 07/18/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency. METHODS Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated. RESULTS Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1-155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development. CONCLUSIONS FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.
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Wang D, Yasseen AS, Marchand-Martin L, Sprague AE, Graves E, Goffinet F, Walker M, Ancel PY, Lacaze-Masmonteil T. A population-based comparison of preterm neonatal deaths (22-34 gestational weeks) in France and Ontario: a cohort study. CMAJ Open 2019; 7:E159-E166. [PMID: 30872267 PMCID: PMC6420330 DOI: 10.9778/cmajo.20180199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The management and outcomes of preterm births can vary greatly even among developed nations with the same access to medicine, technology and expertise. We aimed to compare aspects of obstetrical management and mortality for preterm infants in France and Ontario, Canada. METHODS The Better Outcomes Registry & Network (BORN) Information System in Ontario and Épidémiologique sur les petits âges gestationnels (EPIPAGE-2) in France collected information on maternal demographics, obstetrical characteristics, obstetrical interventions and neonatal outcomes for infants born between 22 and 34 weeks gestation. We used standardized covariate definitions and extracted data from 2011 (for EPIPAGE-2) and from 2012 and 2013 (for BORN) to conduct a cohort study comparing the 2 data sets (stratified into gestational age groups of 22-26, 27-31 and 32-34 wk) using multivariable logistic regression models. RESULTS Mothers in the BORN cohort were older (30.7 yr v. 29.6 yr) but less likely to have gestational hypertension (13.4% v. 17.9%) than those in the EPIPAGE-2 cohort. Infants from EPIPAGE-2 had lower birth weights (1.3 kg v. 1.5 kg) and were more likely to be born in an institution with level 3 care (71.9% v. 55.8%). After adjustment for these differences, there was significantly higher neonatal mortality among infants from EPIPAGE-2 in the 22-26 week gestation age group (adjusted odds ratio 2.81; 95% confidence interval 1.17 to 6.74). INTERPRETATION Even after we adjusted for both intrinsic population differences and differences in management between Ontario and France, we found a higher rate of neonatal mortality at earlier gestational ages in France. This may be related to differences in ethical approaches and/or postnatal management and should be explored further.
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Affiliation(s)
- Dianna Wang
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta.
| | - Abdool S Yasseen
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Laetitia Marchand-Martin
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Ann E Sprague
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Erin Graves
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - François Goffinet
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Mark Walker
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Pierre-Yves Ancel
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
| | - Thierry Lacaze-Masmonteil
- Northern Alberta Neonatal Program (Wang), Edmonton, Alta.; Better Outcomes Registry & Network Ontario (Yasseen, Sprague, Walker); Children's Hospital of Eastern Ontario Research Institute (Yasseen, Sprague), Ottawa, Ont.; Obstetrical, Perinatal and Pediatric Epidemiology Team (Marchand-Martin, Goffinet, Ancel), Centre for Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center (U1153), Institut national de la santé et de la recherche médicale; Paris Descartes University (Marchand-Martin, Goffinet, Ancel), Paris, France; ICES (Graves), Toronto, Ont.; Département Hospitalo-Universitaire on Risks in Pregnancy (Goffinet), Assistance Publique - HÔpitaux de Paris, Paris, France; Department of Obstetrics and Gynecology (Walker), University of Ottawa, Ottawa, Ont.; Clinical Research Unit (Ancel), Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary; Alberta Children's Hospital Research Institute (Lacaze-Masmonteil), Calgary, Alta
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Shahroor M, Lehtonen L, Lee SK, Håkansson S, Vento M, Darlow BA, Adams M, Mori A, Lui K, Bassler D, Morisaki N, Modi N, Noguchi A, Kusuda S, Beltempo M, Helenius K, Isayama T, Reichman B, Shah PS. Unit-Level Variations in Healthcare Professionals' Availability for Preterm Neonates <29 Weeks' Gestation: An International Survey. Neonatology 2019; 116:347-355. [PMID: 31574502 DOI: 10.1159/000501801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/30/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The availability of and variability in healthcare professionals in neonatal units in different countries has not been well characterized. Our objective was to identify variations in the healthcare professionals for preterm neonates in 10 national or regional neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of neonates. METHOD Online, pre-piloted questionnaires about the availability of healthcare professionals were sent to the directors of 390 tertiary neonatal units in 10 international networks: Australia/New Zealand, Canada, Finland, Illinois, Israel, Japan, Spain, Sweden, Switzerland, and Tuscany. RESULTS Overall, 325 of 390 units (83%) responded. About half of the units (48%; 156/325) cared for 11-30 neonates/day and had team-based (43%; 138/325) care models. Neonatologists were present 24 h a day in 59% of the units (191/325), junior doctors in 60% (194/325), and nurse practitioners in 36% (116/325). A nurse-to-patient ratio of 1:1 for infants who are unstable and require complex care was used in 52% of the units (170/325), whereas a ratio of 1:1 or 1:2 for neonates requiring multisystem support was available in 59% (192/325) of the units. Availability of a respiratory therapist (15%, 49/325), pharmacist (40%, 130/325), dietitian (34%, 112/325), social worker (81%, 263/325), lactation consultant (45%, 146/325), parent buddy (6%, 19/325), or parents' resource personnel (11%, 34/325) were widely variable between units. CONCLUSIONS We identified variability in the availability and organization of the healthcare professionals between and within countries for the care of extremely preterm neonates. Further research is needed to associate healthcare workers' availability and outcomes.
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Affiliation(s)
- Maher Shahroor
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Mark Adams
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annalisa Mori
- Neonatal Intensive Care Unit, University Hospital of Siena, Siena, Italy
| | - Kei Lui
- National Perinatal Epidemiology and Statistic Unit, Royal Hospital for Women, University of New South Wales, Randwick, New South Wales, Australia
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Naho Morisaki
- Department of Social Medicine, Neonatal Research Network Japan, National Center for Child Health and Development, Tokyo, Japan
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | | | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, .,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada, .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,
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Hitaka D, Morisaki N, Miyazono Y, Piedvache A, Nagafuji M, Takeuchi S, Kajikawa D, Kanai Y, Saito M, Takada H. Neonatal outcomes of very low birthweight infants born to mothers with hyperglycaemia in pregnancy: a retrospective cohort study in Japan. BMJ Paediatr Open 2019; 3:e000491. [PMID: 31414064 PMCID: PMC6668750 DOI: 10.1136/bmjpo-2019-000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To examine the mortality and morbidities of very low birthweight (VLBW, <1500 g) infants of mothers with hyperglycaemia in pregnancy. DESIGN AND SETTING We conducted a retrospective cohort study using data from the Neonatal Research Network of Japan, a nationwide registry of VLBW infants (2003-2012). PATIENTS We studied 29 626 infants born at 23 to 32 weeks without major congenital anomalies, of which 682 (2.3%) infants were from pregnancies affected by maternal hyperglycaemia. MAIN OUTCOME MEASURES The primary outcome was hospital mortality. Secondary outcomes were neonatal morbidities and their anthropometric values. Associations between maternal hyperglycaemia and each outcome were observed for the overall period, and statistical tests for interaction were conducted to assess whether they differed before or after the adoption of the International Association of Diabetes in Pregnancy Study Group (IADPSG) guidelines in 2010 for the diagnosis of gestational diabetes mellitus. RESULTS Overall, hospital mortality (4.1% vs 5.2%), composite outcomes of mortality and severe morbidity (54.2% vs 60%), and anthropometric values were not significantly different between infants of mothers with or without hyperglycaemia in pregnancy. However, the incidence of respiratory distress syndrome (RDS) in VLBW infants from mothers with hyperglycaemia was significantly higher than those from mothers without it only before (relative risk (RR) 1.09, 95% CI 1.00 to 1.19) and not after (RR 0.97, 95% CI 0.83 to 1.11) the adoption of the IADPSG guidelines. CONCLUSION VLBW infants born to mothers with hyperglycaemia in pregnancy do not seem to be at higher risk of mortality and morbidities, except for RDS only before the adoption of the IADPSG guidelines.
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Affiliation(s)
- Daisuke Hitaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Setagayaku, Tokyo, Japan
| | - Yayoi Miyazono
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aurelie Piedvache
- Department of Social Medicine, National Center for Child Health and Development, Setagayaku, Tokyo, Japan
| | - Motomichi Nagafuji
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Syusuke Takeuchi
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Daigo Kajikawa
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yu Kanai
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Makoto Saito
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.,Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Edstedt Bonamy AK, Zeitlin J, Piedvache A, Maier RF, van Heijst A, Varendi H, Manktelow BN, Fenton A, Mazela J, Cuttini M, Norman M, Petrou S, Reempts PV, Barros H, Draper ES. Wide variation in severe neonatal morbidity among very preterm infants in European regions. Arch Dis Child Fetal Neonatal Ed 2019; 104:F36-F45. [PMID: 29353260 PMCID: PMC6762001 DOI: 10.1136/archdischild-2017-313697] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. DESIGN Area-based cohort study of all births before 32 weeks of gestational age. SETTING 16 regions in 11 European countries in 2011/2012. PATIENTS Survivors to discharge from neonatal care (n=6422). MAIN OUTCOME MEASURES Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. RESULTS 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%-23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50). CONCLUSION Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.
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Affiliation(s)
- Anna Karin Edstedt Bonamy
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes, Paris, France
| | - Aurélie Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes, Paris, France
| | - Rolf F Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heili Varendi
- Department of Pediatrics, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | | | - Alan Fenton
- Newcastle University, Newcastle upon Tyne, UK
| | - Jan Mazela
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, Institute for Research and Health Care, Rome, Italy
| | - Marina Cuttini
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stavros Petrou
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Van Reempts
- Department of Neonatolog, Antwerp University Hospital, University of Antwerp, Antwerp and Study Centre for Perinatal Epidemiology Flanders, Belgium, Europe
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
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Shah PS, Kusuda S, Håkansson S, Reichman B, Lui K, Lehtonen L, Modi N, Vento M, Adams M, Rusconi F, Norman M, Darlow BA, Lodha A, Yang J, Bassler D, Helenius KK, Isayama T, Lee SK. Neonatal Outcomes of Very Preterm or Very Low Birth Weight Triplets. Pediatrics 2018; 142:peds.2018-1938. [PMID: 30463851 DOI: 10.1542/peds.2018-1938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the neonatal outcomes of very preterm triplets with those of matched singletons using a large international cohort. METHODS A retrospective matched-cohort study of preterm triplets and singletons born between 2007 and 2013 in the International Network for Evaluation of Outcomes in neonates database countries and matched by gestational age, sex, and country of birth was conducted. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia). Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated for model 1 (maternal hypertension and birth weight z score) and model 2 (variables in model 1, antenatal steroids, and mode of birth). Models were fitted with generalizing estimating equations and random effects modeling to account for clustering. RESULTS A total of 6079 triplets of 24 to 32 weeks' gestation or 500 to 1499 g birth weight and 18 232 matched singletons were included. There was no difference in the primary outcome between triplets and singletons (23.4% vs 24.0%, adjusted odds ratio: 0.91, 95% CI: 0.83-1.01 for model 1 and 1.00, 95% CI: 0.90-1.11 for model 2). Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. The results were also similar for a subsample of the cohort (1648 triplets and 4944 matched singletons) born at 24 to 28 weeks' gestation. CONCLUSIONS No significant differences were identified in mortality or major neonatal morbidities between triplets who were very low birth weight or very preterm and matched singletons.
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Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics and .,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Departments of Pediatrics and
| | - Satoshi Kusuda
- National Research Network Japan, Department of Pediatrics, Kyorin University, Mitaka, Japan
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Unit of Pediatrics, Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Kei Lui
- Australian and New Zealand Neonatal Network, 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 and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Neena Modi
- United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London and Chelsea and Westminster Hospital, London, United Kingdom
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Franca Rusconi
- TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Abhay Lodha
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kjell K Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shoo K Lee
- Department of Pediatrics and.,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Departments of Pediatrics and.,Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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129
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Costeloe K, Turner MA, Padula MA, Shah PS, Modi N, Soll R, Haumont D, Kusuda S, Göpel W, Chang YS, Smith PB, Lui K, Davis JM, Hudson LD. Sharing Data to Accelerate Medicine Development and Improve Neonatal Care: Data Standards and Harmonized Definitions. J Pediatr 2018; 203:437-441.e1. [PMID: 30293637 DOI: 10.1016/j.jpeds.2018.07.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Kate Costeloe
- Paediatric Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
| | - Michael A Padula
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Prakesh S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Lunenfeld Tannebaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Neena Modi
- Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Roger Soll
- Vermont Oxford Network, Neonatology, University of Vermont College of Medicine, Burlington, VT
| | - Dominique Haumont
- Department of Neonatology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Wolfgang Göpel
- Neonatology and Paediatric Intensive Care, University of Lübeck, Department of Paediatrics, Lübeck, Germany
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kei Lui
- Discipline of Paediatrics, School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jonathan M Davis
- Department of Paediatrics, Floating Hospital for Children, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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130
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Berry MJ, Foster T, Rowe K, Robertson O, Robson B, Pierse N. Gestational Age, Health, and Educational Outcomes in Adolescents. Pediatrics 2018; 142:peds.2018-1016. [PMID: 30381471 DOI: 10.1542/peds.2018-1016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES As outcomes for extremely premature infants improve, up-to-date, large-scale studies are needed to provide accurate, contemporary information for clinicians, families, and policy makers. We used nationwide New Zealand data to explore the impact of gestational age on health and educational outcomes through to adolescence. METHODS We performed a retrospective cohort study of all births in New Zealand appearing in 2 independent national data sets at 23 weeks' gestation or more. We report on 2 separate cohorts: cohort 1, born January 1, 2005 to December 31, 2015 (613 521 individuals), used to study survival and midterm health and educational outcomes; and cohort 2, born January 1, 1998 to December 31, 2000, and surviving to age 15 years (146 169 individuals), used to study high school educational outcomes. Outcomes described by gestational age include survival, hospitalization rates, national well-being assessment outcomes at age 4 years, rates of special education support needs in primary school, and national high school examination results. RESULTS Ten-year survival increased with gestational age from 66% at 23 to 24 weeks to >99% at term. All outcomes measured were strongly related to gestational age. However, most extremely preterm children did not require special educational support and were able to sit for their national high school examinations. CONCLUSIONS Within a publicly funded health system, high-quality survival is achievable for most infants born at periviable gestations. Outcomes show improvement with gestational ages to term. Outcomes at early-term gestation are poorer than for children born at full term.
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Affiliation(s)
- Mary J Berry
- Departments of Paediatrics and Child Health and .,Capital and Coast District Health Board, Wellington, New Zealand; and
| | - Tim Foster
- Public Health, University of Otago, Wellington, Wellington, New Zealand.,Hawke's Bay District Health Board, Napier, New Zealand
| | - Kate Rowe
- Capital and Coast District Health Board, Wellington, New Zealand; and
| | - Oliver Robertson
- Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Bridget Robson
- Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Nevil Pierse
- Public Health, University of Otago, Wellington, Wellington, New Zealand
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131
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Ojeda NB, Alexander BT. Ex Utero Renal Maturation and Reduced Kidney Volume a Predictor of Increased Cardiorenal Risk. Hypertension 2018; 72:832-833. [PMID: 30354727 DOI: 10.1161/hypertensionaha.118.11678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Norma B Ojeda
- From the Departments of Pediatrics (N.B.O.), University of Mississippi-Medical Center, Jackson, MS
| | - Barbara T Alexander
- Physiology and Biophysics (B.T.A.), University of Mississippi-Medical Center, Jackson, MS
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132
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Modepalli V, Kumar A, Sharp JA, Saunders NR, Nicholas KR, Lefèvre C. Gene expression profiling of postnatal lung development in the marsupial gray short-tailed opossum (Monodelphis domestica) highlights conserved developmental pathways and specific characteristics during lung organogenesis. BMC Genomics 2018; 19:732. [PMID: 30290757 PMCID: PMC6173930 DOI: 10.1186/s12864-018-5102-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 09/21/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND After a short gestation, marsupials give birth to immature neonates with lungs that are not fully developed and in early life the neonate partially relies on gas exchange through the skin. Therefore, significant lung development occurs after birth in marsupials in contrast to eutherian mammals such as humans and mice where lung development occurs predominantly in the embryo. To explore the mechanisms of marsupial lung development in comparison to eutherians, morphological and gene expression analysis were conducted in the gray short-tailed opossum (Monodelphis domestica). RESULTS Postnatal lung development of Monodelphis involves three key stages of development: (i) transition from late canalicular to early saccular stages, (ii) saccular and (iii) alveolar stages, similar to developmental stages overlapping the embryonic and perinatal period in eutherians. Differentially expressed genes were identified and correlated with developmental stages. Functional categories included growth factors, extracellular matrix protein (ECMs), transcriptional factors and signalling pathways related to branching morphogenesis, alveologenesis and vascularisation. Comparison with published data on mice highlighted the conserved importance of extracellular matrix remodelling and signalling pathways such as Wnt, Notch, IGF, TGFβ, retinoic acid and angiopoietin. The comparison also revealed changes in the mammalian gene expression program associated with the initiation of alveologenesis and birth, pointing to subtle differences between the non-functional embryonic lung of the eutherian mouse and the partially functional developing lung of the marsupial Monodelphis neonates. The data also highlighted a subset of contractile proteins specifically expressed in Monodelphis during and after alveologenesis. CONCLUSION The results provide insights into marsupial lung development and support the potential of the marsupial model of postnatal development towards better understanding of the evolution of the mammalian bronchioalveolar lung.
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Affiliation(s)
| | - Amit Kumar
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie A Sharp
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Australia.,Institute of Frontiers Materials, Deakin University, Pigdons Road, Geelong, VIC, Australia
| | - Norman R Saunders
- Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
| | - Kevin R Nicholas
- School of Medicine, Deakin University, Pigdons Road, Geelong, VIC, Australia.,Department of Anatomy and Developmental Biology, Monash University, Clayton, Australia.,Monash Institute of Pharmaceutical Science, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, 3052, Australia
| | - Christophe Lefèvre
- School of Medicine, Deakin University, Pigdons Road, Geelong, VIC, Australia. .,Division of Bioinformatics, Walter and Eliza Hall Medical Research Institute, Melbourne, Australia. .,Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia. .,Peter MacCallum Cancer Centre, Melbourne, Australia.
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133
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Evaluation index for asymmetric ventricular size on brain magnetic resonance images in very low birth weight infants. Brain Dev 2018; 40:753-759. [PMID: 29807844 DOI: 10.1016/j.braindev.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/22/2018] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Asymmetric ventriculomegaly is often evident on brain magnetic resonance imaging (MRI) in very low birth weight infants (VLBWI) and is interpreted as white matter injury. However, no evaluation index for asymmetric left-right and anterior-posterior ventricular sizes has been established. METHODS In this retrospective multicenter cohort study, brain T2-weighted MRI was performed at term-equivalent ages in 294 VLBWI born between 2009 and 2011. The value of a lateral ventricular index (LVI) to evaluate asymmetric ventricular size, as well as the relationship between the LVI value and walking at a corrected age of 18 months was investigated. At the level of the foramen of Monro in a horizontal slice, asymmetry between the left and right sides and between the anterior and posterior horns was identified by the corrected width and was detected by a low concordance rate and κ statistic value. An LVI representing the sum of the widths of the four horns of the lateral ventricle corrected for cerebral diameter was devised. RESULTS Asymmetric left-right and anterior-posterior ventricular sizes were confirmed. The LVI value was significantly higher in the non-walking VLBWI group (n = 39) than in the walking VLBWI group (n = 255; 18.2 vs. 15.8, p = 0.02). An LVI cut-off value of 21.5 was associated with non-walking. Multivariate analysis revealed that an LVI value >21.5 was an independent predictor of walking disability at the corrected age of 18 months (odds ratio 2.56, p = 0.008). CONCLUSIONS The LVI value calculated via MRI may predict walking disability at a corrected age of 18 months in VLBWI.
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134
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Morioka I. Hyperbilirubinemia in preterm infants in Japan: New treatment criteria. Pediatr Int 2018; 60:684-690. [PMID: 29906300 DOI: 10.1111/ped.13635] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/04/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
Abstract
In 1992, Kobe University proposed treatment criteria for hyperbilirubinemia in newborns using total serum bilirubin and serum unbound bilirubin reference values. In the last decade, chronic bilirubin encephalopathy has been found to develop in preterm infants in Japan because it can now be clinically diagnosed based on an abnormal signal of the globus pallidus on T2-weighted magnetic resonance imaging and abnormal auditory brainstem response with or without apparent hearing loss, along with physical findings of kinetic disorders with athetosis. We therefore revised the Kobe University treatment criteria for preterm hyperbilirubinemic infants in 2017. The three revised points are as follows: (i) newborns are classified under gestational age at birth or corrected gestational age, not birthweight; (ii) three treatment options were created: standard phototherapy, intensive phototherapy, and albumin therapy and/or exchange blood transfusion; and (iii) initiation of standard phototherapy, intensive phototherapy, and albumin therapy and/or exchange blood transfusion is decided based on the total serum bilirubin and serum unbound bilirubin reference values for gestational weeks at birth at <7 days of age, and on the reference values for corrected gestational age at ≥7 days of age. Studies are needed to establish whether chronic bilirubin encephalopathy can be prevented using the 2017 revised Kobe University treatment criteria for preterm infants in Japan.
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Affiliation(s)
- Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.,Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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135
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Forner O, Schiby A, Ridley A, Thiriez G, Mugabo I, Morel V, Mulin B, Filiatre JC, Riethmuller D, Levy G, Semama D, Martin D, Chantegret C, Bert S, Godoy F, Sagot P, Rousseau T, Burguet A. Extremely premature infants: How does death in the delivery room influence mortality rates in two level 3 centers in France? Arch Pediatr 2018; 25:383-388. [PMID: 30041886 DOI: 10.1016/j.arcped.2018.06.006] [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: 02/09/2018] [Revised: 05/27/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P<0.001). Finally, the neonatal death rate of live-born very preterm neonates admitted to the NICU was significantly lower in center A (25/94, 26.6%) than in center B (27/63, 42.9%; P=0.03). CONCLUSIONS This study points out how the inclusion of deaths in the delivery room when comparing neonatal death rates can lead to a substantial bias in benchmarking studies. Center A and center B each endorsed one of the two models of preferential place of neonatal death (delivery room or NICU) detailed in European studies. The reasons behind the two different models and their impact on how parents perceive supporting their neonate need further investigation.
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Affiliation(s)
- O Forner
- Service maternité-obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - A Schiby
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - A Ridley
- Service médecine pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Thiriez
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - I Mugabo
- Service maternité-obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - V Morel
- Service réanimation néonatale et pédiatrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - B Mulin
- Réseau périnatalité de Franche-Comté, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - J-C Filiatre
- Réseau périnatalité de Franche-Comté, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - D Riethmuller
- Service gynécologie obstétrique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Levy
- Service gynécologie obstétrique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans, France
| | - D Semama
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - D Martin
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C Chantegret
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - S Bert
- Service maternité obstétrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - F Godoy
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service gynécologie obstétrique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - T Rousseau
- Service gynécologie obstétrique, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - A Burguet
- Service réanimation néonatale et pédiatrique, hôpital d'enfants, 14, rue Paul-Gaffarel, 21000 Dijon, France
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136
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Gerull R, Brauer V, Bassler D, Laubscher B, Pfister RE, Nelle M, Müller B, Gerth-Kahlert C, Adams M. Incidence of retinopathy of prematurity (ROP) and ROP treatment in Switzerland 2006-2015: a population-based analysis. Arch Dis Child Fetal Neonatal Ed 2018; 103:F337-F342. [PMID: 28916563 DOI: 10.1136/archdischild-2017-313574] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/08/2017] [Accepted: 08/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a severe complication of preterm birth and can lead to severe visual impairment or even blindness if untreated. The incidence of ROP requiring treatment is increasing in some developed countries in conjunction with higher survival rates at the lower end of gestational age (GA). MATERIAL AND METHODS The incidence of ROP and severe ROP (sROP) requiring treatment in Switzerland was analysed using the SwissNeoNet registry. We conducted a retrospective cohort analysis of very preterm infants with a GA below 32 weeks who were born between 2006 and 2015 in Switzerland. Patient characteristics were stratified according to GA. RESULTS 9.3% and 1.8% of very preterm infants in Switzerland developed ROP of any stage and sROP, respectively. The incidence of ROP treatment was 1.2%. Patients with 24 and 25 weeks GA had the highest proportion of ROP treatment at 14.5% and 7.3%, respectively, whereas the proportion of treated infants at or above a GA of 29 weeks was 0.06%. Similarly, the risk of sROP declined strongly with increasing GA. During the observation period of 10 years, the incidence of ROP treatment ranged between 0.8% and 2.0%. Incidences of sROP or ROP treatment did not increase over time. CONCLUSION The incidence of ROP treatment in Switzerland is low and was stable over the analysed period. The low incidence of sROP in patients with a GA of 29 weeks or more leaves room for a redefinition of ROP screening criteria.
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Affiliation(s)
- Roland Gerull
- Department of Neonatology, Inselspital Bern, Bern, Switzerland.,Department of Neonatology, University Children's Hospital UKBB, Basel, BS, Switzerland
| | - Viviane Brauer
- Department of Neonatology, Inselspital Bern, Bern, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Bernard Laubscher
- Department of Pediatrics, Hôpital Neuchâtelois, Neuchâtel, Switzerland
| | - Riccardo E Pfister
- Department of Neonatology, University Hospital Geneva, Geneva, Switzerland
| | - Mathias Nelle
- Department of Neonatology, Inselspital Bern, Bern, Switzerland
| | - Béatrice Müller
- Department of Intensive Care and Neonatology, Ostschweizer Kinderspital St. Gallen, Gallen, Switzerland
| | | | - Mark Adams
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
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137
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Smith LK, Morisaki N, Morken NH, Gissler M, Deb-Rinker P, Rouleau J, Hakansson S, Kramer MR, Kramer MS. An International Comparison of Death Classification at 22 to 25 Weeks' Gestational Age. Pediatrics 2018; 142:peds.2017-3324. [PMID: 29899042 DOI: 10.1542/peds.2017-3324] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates. METHODS We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11 144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n = 2992), Norway (2010-2014; n = 409), Finland (2010-2015; n = 348), Sweden (2011-2014; n = 489), and Japan (2014-2015; n = 2288) to compare neonatal survival rates using different denominators: all births, births alive at the onset of labor, live births, live births surviving to 1 hour, and live births surviving to 24 hours. RESULTS For births at 22 weeks' gestation, neonatal survival rates for which we used live births as the denominator varied from 3.7% to 56.7% among the 7 countries. This variation decreased when the denominator was changed to include stillbirths (ie, all births [1.8%-22.3%] and fetuses alive at the onset of labor [3.7%-38.2%]) or exclude early deaths and limited to births surviving at least 12 hours (50.0%-77.8%). Similar trends were seen for infants born at 23 weeks' gestation. Variation diminished considerably at 24 and 25 weeks' gestation. CONCLUSIONS International variation in neonatal survival rates at 22 to 23 weeks' gestation diminished considerably when including stillbirths in the denominator, revealing the variation arises in part from differences in the proportion of births reported as live births, which itself is closely connected to the provision of active care.
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Affiliation(s)
- Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Naho Morisaki
- National Center for Child Health and Development, Tokyo, Japan;
| | - Nils-Halvdan Morken
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | - Michael R Kramer
- Department of Epidemiology, Emory University, Atlanta, Georgia; and
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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138
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Trends in the neurodevelopmental outcomes among preterm infants from 2003-2012: a retrospective cohort study in Japan. J Perinatol 2018; 38:917-928. [PMID: 29679045 DOI: 10.1038/s41372-018-0061-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/10/2017] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the trends in mortality and the prevalence of abnormal neurodevelopmental outcomes among preterm Japanese infants. STUDY DESIGN A retrospective multicenter cohort of 30,793 preterm infants born at a gestational age ≤32 weeks, between 2003 and 2012, in the Neonatal Research Network, Japan, was evaluated in the primary analysis. Finally, 13,661 infants were followed-up until 3 years of age and evaluated for neurodevelopmental outcomes, including cerebral palsy (CP), home oxygen therapy (HOT) use, and visual, hearing, and cognitive impairments. Multivariable logistic regression analysis was performed to determine the risk-adjusted trends in mortality and long-term neurodevelopmental outcomes. RESULTS The trends in overall mortality (adjusted odds ratio, (AOR): 0.92; 95% confidence interval, (CI): 0.89-0.94), the prevalence of CP (AOR: 0.95, 95% CI: 0.92-0.98), HOT use (AOR: 0.84, 95% CI: 0.75-0.93), and visual (AOR: 0.84, 95% CI: 0.81-0.87) and hearing impairments (AOR: 0.78, 95% CI: 0.63-0.97) showed a significant downward trend, while cognitive impairment showed no significant changes (AOR: 1.02, 95% CI: 0.99-1.05). Intravenous hyperalimentation was significantly correlated with visual impairment (AOR 0.74, 95% CI 0.59-0.91). Early establishment of enteral feeding was associated with improved long-term outcomes. CONCLUSIONS Mortality was improved, and this did not lead to increased risks for abnormal neurodevelopmental outcomes. Nutritional support might improve long-term neurodevelopmental outcomes.
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139
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Muhe LM, McClure EM, Mekasha A, Worku B, Worku A, Dimtse A, Gebreyesus G, Tigabu Z, Abayneh M, Workneh N, Eshetu B, Girma A, Asefa M, Portales R, Arayaselassie M, Gebrehiwot Y, Bekele T, Bezabih M, Metaferia G, Gashaw M, Abebe B, Geleta A, Shehibo A, Hailu Y, Berta H, Alemu A, Desta T, Hailu R, Patterson J, Nigussie AK, Goldenberg RL. A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol. Reprod Health 2018; 15:116. [PMID: 29945680 PMCID: PMC6020308 DOI: 10.1186/s12978-018-0555-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. METHODS This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. DISCUSSION This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.
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Affiliation(s)
- Lulu M. Muhe
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amha Mekasha
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Dimtse
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Mahlet Abayneh
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Asefa
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ramon Portales
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yirgu Gebrehiwot
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Gesit Metaferia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Hailu Berta
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tigist Desta
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Hailu
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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140
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Cummings JJ, Marlow N. Reducing Variations in Neonatal Outcomes: Look at Practices, Systems, and the Patient. Pediatrics 2018; 141:peds.2018-0402. [PMID: 29654157 DOI: 10.1542/peds.2018-0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- James J Cummings
- Department of Pediatrics, Albany Medical Center, Albany, New York; and
| | - Neil Marlow
- Institute for Women's Health, University College London, London, United Kingdom
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141
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Morisaki N, Isayama T, Samura O, Wada K, Kusuda S. Socioeconomic inequity in survival for deliveries at 22-24 weeks of gestation. Arch Dis Child Fetal Neonatal Ed 2018; 103:F202-F207. [PMID: 28847870 DOI: 10.1136/archdischild-2017-312635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/27/2017] [Accepted: 07/31/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Guidelines recommend individual decision making on resuscitating infants of 22-24 weeks' gestational age (GA) at birth. When the decision not to resuscitate is made, infants would likely die soon after delivery, and under some circumstances such neonatal deaths may be registered as stillbirths occurring during delivery (intrapartum stillbirth). Thus we assessed whether socioeconomic factors are associated with peridelivery deaths (during or within 1 hour of delivery) of infants delivered at 22-24 weeks' gestation. METHODS We analysed 14 726 singletons of 22-24 weeks' GA using the 2003-2011 Japanese vital statistics, and assessed how maternal characteristics influence risk of peridelivery death as well as intrauterine fetal death (IUFD) and death after 1 hour of age until 40 weeks postmenstrual age. RESULTS Living in a municipality with low-average income (lowest tertile (risk ratio 1.32, 95% CI 1.20 to 1.44), middle tertile (risk ratio 1.08, 95% CI 0.98 to 1.19)), younger maternal age (age <20 (risk ratio 1.43, 95% CI 1.17 to 1.75), age 20-34 (risk ratio 1.14, 95% CI 1.03 to 1.27)) and having previous live births (risk ratio 1.08, 95% CI 1.01 to 1.17) increased risk of peridelivery deaths, but did not increase risk of IUFD or deaths after 1 hour of age. Peridelivery death was twice as likely to occur in births to multiparous teenage mothers in a low-income municipality, compared with those of older primiparous mothers in a wealthier municipality. CONCLUSIONS Socioeconomic factors substantially influence whether births of 22-24 weeks' GA survive delivery and the first hour of life. Such disparities may reflect the impact of socioeconomic situations on decision making for resuscitation.
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Affiliation(s)
- Naho Morisaki
- Division of Life-Course Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Tetsuya Isayama
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Division of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Satoshi Kusuda
- Department of Neonatal Medicine, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
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142
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Bergin N, Murtagh J, Philip RK. Maternal Vaccination as an Essential Component of Life-Course Immunization and Its Contribution to Preventive Neonatology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E847. [PMID: 29693575 PMCID: PMC5981886 DOI: 10.3390/ijerph15050847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/13/2018] [Accepted: 04/21/2018] [Indexed: 12/16/2022]
Abstract
Maternal immunisation schedules are increasingly coming under the spotlight as part of the development of lifetime immunisation programmes for the role that they play in improving maternal, foetal, and neonatal health. Maternally-acquired antibodies are critical in protecting infants during the first months of their lives. Maternal immunisation was previously overlooked owing to concerns regarding vaccinations in this untested and high-risk population but is now acknowledged for its potential impact on the outcomes in many domains of foetal and neonatal health, aside from its maternal benefits. This article highlights the role that maternal immunisation may play in reducing infections in preterm and term infants. It explores the barriers to antenatal vaccinations and the optimisation of the immunisation uptake. This review also probes the part that maternal immunisation may hold in the reduction of perinatal antimicrobial resistance and the prevention of non-infectious diseases. Both healthcare providers and expectant mothers should continue to be educated on the importance and safety of the appropriate immunizations during pregnancy. Maternal vaccination merits its deserved priority in a life-course immunization approach and it is perhaps the only immunization whereby two generations benefit directly from a single input. We outline the current recommendations for antenatal vaccinations and highlight the potential advances in the field contributing to “preventive neonatology”.
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Affiliation(s)
- Naomi Bergin
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick V94 C566, Ireland.
| | - Janice Murtagh
- MSD Ireland Ltd., South County Business Park, Leopardstown, Dublin D18 X5K7, Ireland.
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick V94 C566, Ireland.
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143
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Allegaert K, Smits A, van den Anker JN. Drug evaluation studies in neonates: how to overcome the current limitations. Expert Rev Clin Pharmacol 2018; 11:387-396. [PMID: 29421929 DOI: 10.1080/17512433.2018.1439378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Regulatory initiatives have stimulated drug research in infants, but the potential impact of drugs to improve health outcome in neonates remains underexplored. Areas covered: In this review, we focus on current limitations in drug evaluation studies and how to overcome these. The low volume of studies has additional weaknesses such as single center studies, non-commercial sponsorship, overrepresentation of high postulated risk reductions, and underrepresentation of therapeutic exploratory studies. Master protocols and selection criteria for neonatal centers to participate in studies are useful to improve logistics related to performance. Limitations also relate to inaccurate assessment of drug effects (efficacy/safety). This is because of poor symptom recognition, case definitions, and suboptimal data on adverse drug reactions (ADRs) epidemiology. To overcome these limitations, it is necessary to develop core outcome sets, reference values, and specific ADR tools. The limitations identified and approaches suggested to improve drug evaluation are illustrated using neonatal abstinence syndrome as an example. Expert commentary: We anticipate to see an evolving neonatal clinical pharmacology discipline driven by neonatal pathophysiology and knowledge. Multidisciplinary collaborative efforts between health care providers, academia, pharmaceutical industry, advocacy groups and regulatory agencies are crucial to improve the impact of drug evaluation studies in neonates.
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Affiliation(s)
- Karel Allegaert
- a Department of Development and Regeneration , KU Leuven , Leuven , Belgium.,b Intensive Care and Department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands
| | - Anne Smits
- c Neonatal intensive care unit , University Hospitals Leuven , Leuven , Belgium
| | - John N van den Anker
- b Intensive Care and Department of Pediatric Surgery , Erasmus MC-Sophia Children's Hospital , Rotterdam , the Netherlands.,d Division of Clinical Pharmacology, Department of Pediatrics , Children's National Health System , Washington, DC , USA.,e Division of Paediatric Pharmacology and Pharmacometrics , University of Basel Children's Hospital , Basel , Switzerland
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144
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Onland W, Merkus MP, Nuytemans DH, Jansen-van der Weide MC, Holman R, van Kaam AH. Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants (the SToP-BPD study): statistical analysis plan. Trials 2018. [PMID: 29523175 PMCID: PMC5845134 DOI: 10.1186/s13063-018-2505-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth with short-term and long-term adverse consequences. Although the glucocorticoid dexamethasone has been proven to be beneficial for the prevention of BPD, there are concerns about an increased risk of adverse neurodevelopmental outcome. Hydrocortisone has been suggested as an alternative therapy. The aim of the Systemic Hydrocortisone To Prevent Bronchopulmonary Dysplasia in preterm infants (SToP-BPD) trial is to assess the efficacy and safety of postnatal hydrocortisone administration for the reduction of death or BPD in ventilator-dependent preterm infants. Methods/design The SToP-BPD study is a multicentre, double-blind, placebo-controlled hydrocortisone trial in preterm infants at risk for BPD. After parental informed consent is obtained, ventilator-dependent infants are randomly allocated to hydrocortisone or placebo treatment during a 22-day period. The primary outcome measure is the composite outcome of death or BPD at 36 weeks postmenstrual age. Secondary outcomes are short-term effects on pulmonary condition and long-term neurodevelopmental sequelae assessed at 2 years corrected age. Complications of treatment, other serious adverse events and suspected unexpected serious adverse reactions are reported as safety outcomes. This pre-specified statistical analysis plan was written and submitted without knowledge of the unblinded data. Trial registration Netherlands Trial Register, NTR2768. Registered on 17 February 2011. EudraCT, 2010-023777-19. Registered on 2 November 2010.
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Affiliation(s)
- Wes Onland
- Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Room H3-145, PO Box 22700, 1100, DD, Amsterdam, The Netherlands.
| | - Maruschka P Merkus
- Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Debbie H Nuytemans
- Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Room H3-145, PO Box 22700, 1100, DD, Amsterdam, The Netherlands
| | | | - Rebecca Holman
- Clinical Research Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Centre, Room H3-145, PO Box 22700, 1100, DD, Amsterdam, The Netherlands
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145
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Beltempo M, Lacroix G, Cabot M, Blais R, Piedboeuf B. Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants. J Perinatol 2018; 38:175-180. [PMID: 28933776 DOI: 10.1038/jp.2017.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/14/2017] [Accepted: 08/11/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. STUDY DESIGN Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight <1000 g admitted at a 56 bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). RESULTS Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). CONCLUSION High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.
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Affiliation(s)
- M Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - G Lacroix
- Department of Economics, Université Laval, Ville de Québec, QC, Canada
| | - M Cabot
- Department of Pediatrics, CHU de Québec and Université Laval, Ville de Québec, QC, Canada
| | - R Blais
- Department of Health Administration, Université de Montreal, Montreal, QC, Canada
| | - B Piedboeuf
- Department of Pediatrics, CHU de Québec and Université Laval, Ville de Québec, QC, Canada
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146
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Pimenta JM, Ebeling M, Montague TH, Beach KJ, Abell J, O'Shea MT, Powell M, Hulsey TC. A Retrospective Database Analysis of Neonatal Morbidities to Evaluate a Composite Endpoint for Use in Preterm Labor Clinical Trials. AJP Rep 2018; 8. [PMID: 29527406 PMCID: PMC5842077 DOI: 10.1055/s-0038-1635097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To propose and assess a composite endpoint (CE) of neonatal benefit based on neonatal mortality and morbidities by gestational age (GA) for use in preterm labor clinical trials. Study Design A descriptive, retrospective analysis of the Medical University of South Carolina Perinatal Information System database was conducted. Neonatal morbidities were assessed for inclusion in the CE based on clinical significance/risk of childhood neurodevelopmental impairment, frequency, and association with GA in a mother-neonate linked cohort, comprising women with uncomplicated singleton pregnancies delivered at ≥24 weeks' GA. Results Among 17,912 mother-neonate pairs, neonates were at a risk of numerous severe but infrequent morbidities. Clinically important, predominantly rare events were combined into a CE comprising neonatal mortality and morbidities, which decreased in frequency with increasing GA. The highest CE frequency occurred at <31 weeks. High frequency of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis drove the CE. Median length of hospital stay was longer at all GAs in those with the CE compared with those without. Conclusions Descriptive epidemiological assessment and clinical input were used to develop a CE to measure neonatal benefit, comprising clinically meaningful outcomes. These empirical data and CE allowed trials investigating tocolytics to be sized appropriately.
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Affiliation(s)
- Jeanne M Pimenta
- Real World Evidence (Epidemiology), GSK, Uxbridge, Middlesex, United Kingdom
| | - Myla Ebeling
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | | | - Kathleen J Beach
- Maternal Neonatal Health Unit, GSK, Research Triangle Park, North Carolina
| | - Jill Abell
- Clinical Effectiveness and Safety Clinical Evaluation Science, GSK, Philadelphia, Pennsylvania.,Janssen Scientific Affairs, Real World Evidence, Philadelphia, Pennsylvania
| | - Michael T O'Shea
- Department of Pediatrics (Neonatology Section), University of North Carolina, Chapel Hill, North Carolina
| | - Marcy Powell
- Safety Evaluation and Risk Mitigation, GSK, Research Triangle Park, North Carolina
| | - Thomas C Hulsey
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.,Department of Epidemiology, West Virginia University, Morgantown, West Virginia
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147
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Beltempo M, Isayama T, Vento M, Lui K, Kusuda S, Lehtonen L, Sjörs G, Håkansson S, Adams M, Noguchi A, Reichman B, Darlow BA, Morisaki N, Bassler D, Pratesi S, Lee SK, Lodha A, Modi N, Helenius K, Shah PS. Respiratory Management of Extremely Preterm Infants: An International Survey. Neonatology 2018; 114:28-36. [PMID: 29656287 DOI: 10.1159/000487987] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies. OBJECTIVE To evaluate practice variations in the respiratory management of extremely preterm infants born at < 29 weeks' gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration. METHODS A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015. RESULTS Overall, 321 of the 390 units responded (82%). The majority of units within networks (40-92%) mechanically ventilate infants born at 23-24 weeks' GA on continuous positive airway pressure (CPAP) with 30-39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25-26 weeks' GA at similar settings varied significantly (20-85% of units within networks). The most common respiratory strategy for infants born at 27-28 weeks' GA on CPAP with 30-39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0-60%), CPAP (3-82%), intubation and surfactant administration with immediate extubation (0-75%), and less invasive surfactant administration (0-68%). CONCLUSIONS There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes.
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Affiliation(s)
- Marc Beltempo
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tetsuya Isayama
- Clinical Epidemiology and Biostatistics, McMaster University, Toronto, Ontario, Canada
| | - Máximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Kei Lui
- Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Liisa Lehtonen
- Department of Pediatrics, Turku University Hospital, University of Turku, Turku, Finland
| | - Gunnar Sjörs
- Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - Brian A Darlow
- Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Naho Morisaki
- Neonatal Research Network Japan, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Simone Pratesi
- TIN Toscane Online, Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Shoo K Lee
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Abhay Lodha
- Pediatrics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Kjell Helenius
- Department of Pediatrics, Turku University Hospital, University of Turku, Turku, Finland
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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148
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Rivera-Rueda M, Fernández-Carrocera L, Michel-Macías C, Carrera-Muiños S, Arroyo-Cabrales L, Coronado-Zarco I, Cardona-Pérez J. Morbilidad y mortalidad de neonatos < 1,500 g ingresados a la UCIN de un hospital de tercer nivel de atención. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2017. [DOI: 10.1016/j.rprh.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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149
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Helenius K, Sjörs G, Shah PS, Modi N, Reichman B, Morisaki N, Kusuda S, Lui K, Darlow BA, Bassler D, Håkansson S, Adams M, Vento M, Rusconi F, Isayama T, Lee SK, Lehtonen L. Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks. Pediatrics 2017; 140:peds.2017-1264. [PMID: 29162660 DOI: 10.1542/peds.2017-1264] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHODS A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. RESULTS Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. CONCLUSIONS The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.
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Affiliation(s)
- Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland; .,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Gunnar Sjörs
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Neena Modi
- United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, and Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Lui
- Royal Hospital for Women, and National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Randwick, Australia
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stellan Håkansson
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain; and
| | - Franca Rusconi
- TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy and Regional Health Agency of Tuscany, Florence, Italy
| | - Tetsuya Isayama
- Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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150
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Ebrahim E, Paulsson L. The impact of premature birth on the permanent tooth size of incisors and first molars. Eur J Orthod 2017; 39:622-627. [PMID: 28371880 DOI: 10.1093/ejo/cjx021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Scientific evidence is insufficient to answer the question of whether premature birth causes altered tooth-crown dimensions. Objective To evaluate permanent tooth-crown dimensions in prematurely born children and to compare the findings with full-term born controls. Subjects and Methods Preterm children of 8-10 years of age were selected from the Swedish Medical Birth Register. One group consisted of 36 extremely preterm children (born before the 29th gestational week); the other group included 37 very preterm children (born during gestational weeks 29-32). The preterm children were compared with 41 matched full-term born children. Clinical examination and study casts were performed on all children. Permanent maxillary and mandibular first molars, central incisors, and laterals were measured with a digital sliding caliper on study casts. The tooth-crowns were measured both mesio-distal and bucco-lingual. Results Both the mesio-distal and bucco-lingual measurements in the maxillary and mandibular first molars had a significantly smaller width in the extremely preterm group compared with the full-term group. The central incisors and lower laterals were significantly smaller mesio-distally in the extremely preterm group compared to the full-term group. A reduction in tooth size of 4-9% was found between the extremely preterm group and the full-term group for both boys and girls. The maxillary first molars and mandibular left first molar were also smaller mesio-distally in the extremely preterm group compared to the very preterm group. The results indicate that the more preterm the birth, the smaller the tooth-crown dimensions. Independent of gestational age girls had generally smaller teeth than boys. Conclusion Premature birth is associated with reduced tooth-crown dimensions of permanent incisors and first molars.
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Affiliation(s)
- Eman Ebrahim
- Department of Orthodontics, Faculty of Dentistry, Sebha university, Sebha, Libya
- Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Liselotte Paulsson
- Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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