1
|
Chawla D. Survival of Very-Low-Birth-Weight Neonates in India. Indian J Pediatr 2021; 88:326-327. [PMID: 33675026 DOI: 10.1007/s12098-021-03710-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, 160 030, India.
| |
Collapse
|
2
|
Tapia JL, Toso A, Vaz Ferreira C, Fabres J, Musante G, Mariani G, Herrera TI, D'Apremont I. The unfinished work of neonatal very low birthweight infants quality improvement: Improving outcomes at a continental level in South America. Semin Fetal Neonatal Med 2021; 26:101193. [PMID: 33478876 DOI: 10.1016/j.siny.2021.101193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neonatal mortality rate varies between 4.2 and 18.6 per thousand by country in South America. There is little information regarding the outcomes of very low birth weight infants in the region and mortality rates are extremely variable ranging from 6% to over 50%. This group may represent up to 50-70% of the neonatal mortality and approximately 25-30% of infant mortality. Some initiatives, like the NEOCOSUR Network, have systematically collected and analyzed epidemiological information on VLBW infants' outcomes in the region. Over a 16-year period, survival without major morbidity improved from 37 to 44%. However, mortality has remained almost unchanged at approximately 27%, despite an increase in the implementation of the best available evidence in perinatal practices over time. Implementing quality improvement initiatives in the continent is particularly challenging but represents a great opportunity considering that there is a wide margin for progress in both care and outcomes.
Collapse
Affiliation(s)
- J L Tapia
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - A Toso
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - C Vaz Ferreira
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de La República, Montevideo, Uruguay.
| | - J Fabres
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - G Musante
- Department of Maternal and Child Health, Hospital Universitario Austral, Pilar, Argentina.
| | - G Mariani
- Department of Pediatrics, Division of Neonatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - T I Herrera
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de La República, Montevideo, Uruguay.
| | - I D'Apremont
- Department of Neonatology, Pontificia Universidad Católica de Chile, Santiago, Chile.
| |
Collapse
|
3
|
Choi CW, Park MS. Data Management and Site-Visit Monitoring of the Multi-Center Registry in the Korean Neonatal Network. J Korean Med Sci 2015; 30 Suppl 1:S19-24. [PMID: 26566353 PMCID: PMC4641058 DOI: 10.3346/jkms.2015.30.s1.s19] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/23/2015] [Indexed: 11/20/2022] Open
Abstract
The Korean Neonatal Network (KNN), a nationwide prospective registry of very-low-birth-weight (VLBW, < 1,500 g at birth) infants, was launched in April 2013. Data management (DM) and site-visit monitoring (SVM) were crucial in ensuring the quality of the data collected from 55 participating hospitals across the country on 116 clinical variables. We describe the processes and results of DM and SVM performed during the establishment stage of the registry. The DM procedure included automated proof checks, electronic data validation, query creation, query resolution, and revalidation of the corrected data. SVM included SVM team organization, identification of unregistered cases, source document verification, and post-visit report production. By March 31, 2015, 4,063 VLBW infants were registered and 1,693 queries were produced. Of these, 1,629 queries were resolved and 64 queries remain unresolved. By November 28, 2014, 52 participating hospitals were visited, with 136 site-visits completed since April 2013. Each participating hospital was visited biannually. DM and SVM were performed to ensure the quality of the data collected for the KNN registry. Our experience with DM and SVM can be applied for similar multi-center registries with large numbers of participating centers.
Collapse
Affiliation(s)
- Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon Sung Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
4
|
Abstract
Currently, in the Republic of Korea, despite the very-low-birth rate, the birth rate and number of preterm infants are markedly increasing. Neonatal deaths and major complications mostly occur in premature infants, especially very-low-birth-weight infants (VLBWIs). VLBWIs weigh less than 1,500 g at birth and require intensive treatment in a neonatal intensive care unit (NICU). The operation of the Korean Neonatal Network (KNN) officially started on April 15, 2013, by the Korean Society of Neonatology with support from the Korea Centers for Disease Control and Prevention. The KNN is a national multicenter neonatal network based on a prospective web-based registry for VLBWIs. About 2,000 VLBWIs from 60 participating hospital NICUs are registered annually in the KNN. The KNN has built unique systems such as a web-based real-time data display on the web site and a site-visit monitoring system for data quality surveillance. The KNN should be maintained and developed further in order to generate appropriate, population-based, data-driven, health-care policies; facilitate active multicenter neonatal research, including quality improvement of neonatal care; and ultimately lead to improvement in the prognosis of high-risk newborns and subsequent reduction in health-care costs through the development of evidence-based neonatal medicine in Korea.
Collapse
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Young Park
- Division of Cardiovascular and Rare Diseases, the Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Lee BS, Moon WH, Park EA. Real-time Data Display System of the Korean Neonatal Network. J Korean Med Sci 2015; 30 Suppl 1:S12-8. [PMID: 26566352 PMCID: PMC4641057 DOI: 10.3346/jkms.2015.30.s1.s12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/21/2015] [Indexed: 11/20/2022] Open
Abstract
Real-time data reporting in clinical research networks can provide network members through interim analyses of the registered data, which can facilitate further studies and quality improvement activities. The aim of this report was to describe the building process of the data display system (DDS) of the Korean Neonatal Network (KNN) and its basic structure. After member verification at the KNN member's site, users can choose a variable of interest that is listed in the in-hospital data statistics (for 90 variables) or in the follow-up data statistics (for 54 variables). The statistical results of the outcome variables are displayed on the HyperText Markup Language 5-based chart graphs and tables. Participating hospitals can compare their performance to those of KNN as a whole and identify the trends over time. Ranking of each participating hospital is also displayed in terms of key outcome variables such as mortality and major neonatal morbidities with the names of other centers blinded. The most powerful function of the DDS is the ability to perform 'conditional filtering' which allows users to exclusively review the records of interest. Further collaboration is needed to upgrade the DDS to a more sophisticated analytical system and to provide a more user-friendly interface.
Collapse
Affiliation(s)
- Byong Sop Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | | | - Eun Ae Park
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Quality improvement in neonatal care - a new paradigm for developing countries. Indian J Pediatr 2014; 81:1367-72. [PMID: 24705935 DOI: 10.1007/s12098-014-1406-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Abstract
Infrastructure for facility-based neonatal care has rapidly grown in India over last few years. Experience from developed countries indicates that different health facilities have varying clinical outcomes despite accounting for differences in illness severity of admitted neonates and random variation. Variation in quality of care provided at different neonatal units may account for variable clinical outcomes. Monitoring quality of care, comparing outcomes across different centers and conducting collaborative quality improvement projects can improve outcome of neonates in health facilities. Top priority should be given to establishing quality monitoring and improvement procedures at special care neonatal units and neonatal intensive care units of the country. This article presents an overview of methods of quality improvement. Literature reports of successful collaborative quality improvement projects in neonatal health are also reviewed.
Collapse
|
7
|
Darlow BA, Gilbert CE, Quiroga AM. Setting up and improving retinopathy of prematurity programs: interaction of neonatology, nursing, and ophthalmology. Clin Perinatol 2013; 40:215-27. [PMID: 23719306 DOI: 10.1016/j.clp.2013.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Retinopathy of prematurity (ROP) programs require collaboration between neonatologists, ophthalmologists, nurses, and allied health personnel, together with parents. The concept of a ROP program will vary according to the setting. However, in every situation there should be 2 main aspects: primary prevention of ROP through better overall care, and secondary prevention through case detection (often called screening), treatment, and follow-up. ROP programs will have different content and emphasis according to whether the setting is in an economically advanced or developing country.
Collapse
Affiliation(s)
- Brian A Darlow
- Department of Paediatrics, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
| | | | | |
Collapse
|
8
|
Chang YS, Ahn SY, Park WS. The Establishment of the Korean Neonatal Network (KNN). NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.2.169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
9
|
MacDougall J, Creighton SM, Wood PL. Clinical networks in paediatric and adolescent gynaecology. BJOG 2009; 117:131-3. [DOI: 10.1111/j.1471-0528.2009.02384.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Donoghue DA, Henderson-Smart DJ. The establishment of the Australian and New Zealand Neonatal Network. J Paediatr Child Health 2009; 45:400-4. [PMID: 19712174 DOI: 10.1111/j.1440-1754.2009.01527.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Australian and New Zealand Neonatal Network was established in 1994 to monitor high-risk newborns admitted for care. Uniquely, all units in both countries have participated since inception, making it integral to the care of babies. The network's objectives include auditing care, publishing aggregated results annually, providing feedback to units, monitoring technologies and developing clinical indicators. Networking provides a forum for clinicians and a consortium of knowledge and advice. It facilitates collaborative research and clinical groups, producing projects from observational studies to randomised controlled trials. Members take a major role in reviewing the evidence for care and ensuring its effective use in clinical practice.
Collapse
Affiliation(s)
- Deborah A Donoghue
- Northern Rivers University Department of Rural Health, Lismore, NSW 2480, Australia.
| | | | | |
Collapse
|
11
|
Doyle LW. The burden of illness in perinatal and neonatal care: the epidemiologist's role. Semin Fetal Neonatal Med 2006; 11:69-72. [PMID: 16483860 DOI: 10.1016/j.siny.2005.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical research to improve outcomes of pregnancy and perinatal/neonatal care and to reduce the burden of illness is grounded in modern principles of evidence-based clinical practice. The central tool for creating convincing evidence is the randomised controlled trial (RCT). However, creating evidence is only one step to the overall goal of reducing the burden of illness. Once new evidence has been created by a RCT it must be synthesised with existing evidence, the evidence must be applied and disseminated into clinical practice, and the effect of the new evidence on the specific illness being targeted must be re-evaluated. Perinatal/neonatal epidemiologists require multiple skills to understand not only how to evaluate the burden of illness and to identify problems that might have solutions, but also how to create and synthesise evidence, apply it in practice and evaluate its clinical application, even though they need not be equally expert in all areas.
Collapse
Affiliation(s)
- Lex W Doyle
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, 132 Grattan St, Carlton, Victoria 3053, and University of Melbourne, Melbourne, Australia.
| |
Collapse
|