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Mohammad K, Thomas S, Joseph CJ, O'Keef C, Leswick L, Montpetit J, Fiedrich E, Rombough B, Thomas S. Structured Referral Call Handling Process Improves Neonatal Transport Dispatch Times. Am J Perinatol 2024; 41:e2209-e2215. [PMID: 37429321 DOI: 10.1055/s-0043-1771016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handling process change to expedite transport team mobilization. This study compares the impact of this change on neonatal transport decision to dispatch and mobilization times. STUDY DESIGN This retrospective cohort study was conducted using a historical cohort of neonates referred for transportation between January 2017 and December 2021. The "dispatch time" (DT) was the time from the start of consultation to the time a decision to dispatch the transport team was made, whereas "mobilization time" (MT) referred to the time from start of consultation to the time the team departed the home base. In 2019, a DT target of <3 minutes was implemented to meet a target MT of <15 and <30 minutes for emergent and urgent high-risk transport referral calls, respectively. In 2021 use of the "Situation" component of the SBAR (Situation, Background, Assessment, Recommendation) communication tool was introduced with the transport team asking five questions to determine need for mobilization. Data between 2017 and 2018 represented the preintervention period, 2019, the "washout" period for implementation, and 2020 to 2021, the postintervention period. Data were analyzed to determine trends in DT and MT. RESULTS The DT was reduced from a median of 5 to 3 minutes following intervention (p < 0.001). DT target goal of 3 minutes was achieved in 67.08% of calls compared with 26.24% in the preintervention period, (p < 0.001). The team achieved MT target goals in 42.71% of urgent and emergent transfers compared with 18.05% prior to intervention (p < 0.001). CONCLUSION Introduction of a time-sensitive referral call handling process improved dispatch and mobilization time of the neonatal transport team. KEY POINTS · Time-sensitive triaging of neonatal transport referrals improves dispatch and mobilization time.. · A structured referral call handling process improves the efficiency of neonatal transport decision-making.. · Dedicated neonatal transport vehicles are likely to improve neonatal transport mobilization time..
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Affiliation(s)
- Khorshid Mohammad
- Division of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Soumya Thomas
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chacko J Joseph
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsea O'Keef
- Division of Neonatology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Leah Leswick
- Division of Neonatology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - John Montpetit
- Alberta Health Service, Referral, Access, Advice, Placement, Information and Destination (RAAPID), Emergency Medical Services Stonegate Building, Calgary, Alberta, Canada
| | - Elsa Fiedrich
- Division of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Bryan Rombough
- Alberta Health Service, Southern Alberta Neonatal Transport Service, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Sumesh Thomas
- Division of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Abdelmawla M, Hansen G, Narvey M, Whyte H, Ilodigwe D, Lee KS. Evaluation of transport-related outcomes for neonatal transport teams with and without physicians. Paediatr Child Health 2021; 26:e290-e296. [PMID: 34880960 DOI: 10.1093/pch/pxab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/18/2021] [Indexed: 11/14/2022] Open
Abstract
Objective The aim of this study was to evaluate if the presence of a physician in the neonatal transport team (NTT) affects transport-related outcomes and procedural success. Design Retrospective cohort study with propensity score matching. Setting Canadian national study. Patients Neonatal transports from nontertiary centres between January 2014 and December 2017. Interventions Comparison of transports conducted by NTTs with physicians (MD Group) and without physicians (noMD Group). Main outcome measures The primary outcome was the change in patient acuity as measured by the transport risk index of physiologic severity (TRIPS) score. Secondary outcomes included mortality within 24 hours of NICU admission, clinical complications during transport, procedural success, and stabilization time. Results Among 9,703 eligible cases, 899 neonatal transports attended by NTTs with physicians were compared to 899 neonatal transports without physicians using propensity score matching. No differences were seen in the improvement of TRIPS score or mortality ≤24 hours of NICU admission. The MD Group had more clinical complications (7.7% versus 5.0%, P=0.02). No differences were seen in success rates of invasive procedures. The MD Group had shorter stabilization times. In multivariable analysis, the MD Group was not a significant predictor for the improvement in TRIPS score after adjustment for covariates. Conclusions Neonatal transports conducted by teams including physicians compared to teams without physicians, did not have higher improvement in TRIPS scores and had similar success rates for procedures. These results provide insights for the planning of the structure and training of specialized interfacility neonatal transport programs.
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Affiliation(s)
- Mohamed Abdelmawla
- Division of Neonatology, Children's Hospital of Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Hansen
- Division of Critical Care, Royal University Hospital, Saskatoon, Saskatchewan, Canada.,Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael Narvey
- Division of Neonatology, Children's Hospital of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hilary Whyte
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Don Ilodigwe
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Fifty Years of Progress in Neonatal and Maternal Transport for Specialty Care. J Obstet Gynecol Neonatal Nurs 2021; 50:774-788. [PMID: 34166650 DOI: 10.1016/j.jogn.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/23/2022] Open
Abstract
Specialty care for preterm and critically ill infants has evolved over many years. Neonatal intensive care nurseries were developed, and physicians and nurses learned how to provide intensive care for these infants. Neonatal and maternal (in utero) transport to tertiary centers became common in regionalized systems of care to facilitate the specialized care of high-risk neonates when childbirth occurred in settings without specialized personnel or equipment. Annually, nearly 70,000 neonatal transports occur in the United States. Although specialty care helps reduce rates of neonatal mortality, racial disparities and disparities between urban and rural areas exist. The purpose of this article is to review the progress achieved in neonatal and maternal transport over the past 50 years. The knowledge developed can be used to improve the care provided to women, their fetuses, and infants.
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Impact of transport on arrival status and outcomes in newborns with heart disease: a low-middle-income country perspective. Cardiol Young 2020; 30:1001-1008. [PMID: 32513322 DOI: 10.1017/s1047951120001420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to systematically study determinants of "clinical status at arrival after transport" of neonates with CHD and its impact on clinical outcomes in a low- and middle-income country environment. METHODS AND RESULTS Consecutive neonates with CHD (n = 138) transported (median distance 138 km; 5-425 km) to a paediatric cardiac programme in Southern India were studied prospectively. Among 138 neonatal transports, 134 were in ambulances. Four neonates were transported by family in private vehicles; 60% with duct-dependent circulation (n = 57) were transported without prostaglandin E1. Clinical status at arrival after transport was assessed using California modification of TRIPS Score (Ca-TRIPS), evidence of end-organ injury and metabolic insult.Upon arrival, 42% had end-organ injury, 24% had metabolic insult and 36% had Ca-TRIPS Score >25. Prior to surgery or catheter intervention, prolonged ICU stay (>48 hours), prolonged ventilation (>48 hours), blood stream sepsis, and death occurred in 48, 15, 19, and 3.6%, respectively. Ca-TRIPS Score >25 was significantly associated with mortality (p = 0.005), sepsis (p = 0.035), and prolonged ventilation (p < 0.001); end-organ injury with prolonged ICU stay (p = 0.031) and ventilation (p = 0.045); metabolic insult with mortality (p = 0.012) and sepsis (p = 0.015).Fifteen babies needed only medical management, 10 received comfort care (due to severe end-organ injury in 3), 107 underwent cardiac surgery (n = 83) or catheter intervention (n = 24), with a mortality of 6.5%. Clinical status at arrival after transport did not impact post-procedure outcomes. CONCLUSION Neonates with CHD often arrive in suboptimal status after transport in low- and middle-income countries resulting in adverse clinical outcomes. Robust transport systems need to be integrated in plans to develop newborn heart surgery in low- and middle-income countries.
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Lee KS. Neonatal transport metrics and quality improvement in a regional transport service. Transl Pediatr 2019; 8:233-245. [PMID: 31413957 PMCID: PMC6675684 DOI: 10.21037/tp.2019.07.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/03/2019] [Indexed: 11/06/2022] Open
Abstract
Sick neonates in non-tertiary centers rely on the expert skills of neonatal transport teams (NTTs) and efficient systems to provide safe and timely transport to tertiary centers. Quality metrics to measure and compare performance among transport teams are essential to ensure delivery of high-quality care and efficient use of limited and costly resources. We review the most relevant quality metrics available in neonatal transport and key issues to consider during their utilization. The use of quality metrics for quality improvement is described through the experience of a neonatal transport program based at a quaternary children's hospital in Canada.
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Affiliation(s)
- Kyong-Soon Lee
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Thompson K, Gardiner J, Resnick S. Outcome of outborn infants at the borderline of viability in Western Australia: A retrospective cohort study. J Paediatr Child Health 2016; 52:728-33. [PMID: 27149045 DOI: 10.1111/jpc.13187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 01/08/2023]
Abstract
AIM Preterm infants have a high risk of morbidity and mortality, which increases with decreasing gestational age. Inborn infants (infants born in tertiary perinatal centres) have higher survival and lower morbidity than outborn infants. We aimed to compare short-term and 1-year developmental outcomes of outborn infants at the borderline of viability (≥23 to ≤25 + 6 weeks gestation) with a similar cohort of inborn infants in the sole tertiary perinatal centre in Western Australia from 2001 to 2011. METHODS This was a retrospective cohort study. Outborn infants ≥23 to ≤25 + 6 weeks gestation who survived to be transported to the Neonatal Intensive Care Unit (NICU) in the perinatal centre were contemporaneously matched to the next inborn infant of comparable gestation and birth weight. We compared mortality, morbidity (including intraventricular haemorrhage, necrotising enterocolitis and chronic lung disease) and Griffiths General Quotient scores at 1-year corrected age. RESULTS There were 54 outborn and 519 inborn births in the gestational age range during the study period. Thirty-five (65%) outborn infants were transported to the NICU. Of the outborn infants, 21/54 (39%) survived to discharge compared with 375/519 (72%) inborn infants. For the 35 outborn infants transported to NICU, 14 (40%) died, compared with 6/35 (17%) of inborn infants. There were no differences in short-term and developmental outcomes in surviving infants. CONCLUSIONS Outborn extremely preterm infants <26 weeks gestation have higher mortality than inborn counterparts. However, those transported to a tertiary NICU have similar morbidity and developmental outcomes.
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Affiliation(s)
- Kirsten Thompson
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Jacqueline Gardiner
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Steven Resnick
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Princess Margaret Hospital, Subiaco, Western Australia, Australia
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Chang ASM, Berry A, Jones LJ, Sivasangari S. Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality. Cochrane Database Syst Rev 2015; 2015:CD007485. [PMID: 26508087 PMCID: PMC9239562 DOI: 10.1002/14651858.cd007485.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Maternal antenatal transfers provide better neonatal outcomes. However, there will inevitably be some infants who require acute transport to a neonatal intensive care unit (NICU). Because of this, many institutions develop services to provide neonatal transport by specially trained health personnel. However, few studies report on relevant clinical outcomes in infants requiring transport to NICU. OBJECTIVES To determine the effects of specialist transport teams compared with non-specialist transport teams on the risk of neonatal mortality and morbidity among high-risk newborn infants requiring transport to neonatal intensive care. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE (1966 to 31 July 2015), EMBASE (1980 to 31 July 2015), CINAHL (1982 to 31 July 2015), conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. STUDY DESIGN randomised, quasi-randomised or cluster randomised controlled trials. POPULATION neonates requiring transport to a neonatal intensive care unit. INTERVENTION transport by a specialist team compared to a non-specialist team. OUTCOMES any of the following outcomes - death; adverse events during transport leading to respiratory compromise; and condition on admission to the neonatal intensive care unit. DATA COLLECTION AND ANALYSIS The methodological quality of the trials was assessed using the information provided in the studies and by personal communication with the author. Data on relevant outcomes were extracted and the effect size estimated and reported as risk ratio (RR), risk difference (RD), number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) and mean difference (MD) for continuous outcomes. Data from cluster randomised trials were not combined for analysis. MAIN RESULTS One trial met the inclusion criteria of this review but was considered ineligible owing to serious bias in the reporting of the results. AUTHORS' CONCLUSIONS There is no reliable evidence from randomised trials to support or refute the effects of specialist neonatal transport teams for neonatal retrieval on infant morbidity and mortality. Cluster randomised trial study designs may be best suited to provide us with answers on effectiveness and clinical outcomes.
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Affiliation(s)
- Alvin SM Chang
- KK Women's and Children's HospitalDepartment of Neonatology100 Bukit Timah RoadSingaporeSingapore229899
| | - Andrew Berry
- University of New South WalesNewborn & paediatric Emergency Transport Service (NETS) ‐ NSWSydneyNew South WalesAustralia
| | - Lisa J Jones
- University of SydneyCentral Clinical School, Discipline of Obstetrics, Gynaecology and NeonatologyCamperdownNSWAustralia
| | - Subramaniam Sivasangari
- Penang HospitalClinical Research CenterMinistry of HealthJalan ResidensiGeorgetownPenangMalaysia10990
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Whyte HEA, Jefferies AL. The interfacility transport of critically ill newborns. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.265] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lebel V, Alderson M, Aita M. Physiological stability: a concept analysis. J Adv Nurs 2014; 70:1995-2004. [DOI: 10.1111/jan.12391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Valerie Lebel
- Faculty of Nursing; University of Montreal; Quebec Canada
| | - Marie Alderson
- Faculty of Nursing; University of Montreal; Quebec Canada
| | - Marilyn Aita
- Faculty of Nursing; University of Montreal; Quebec Canada
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Estimating the quality of neonatal transport in California. J Perinatol 2013; 33:964-70. [PMID: 24071907 DOI: 10.1038/jp.2013.57] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/12/2013] [Accepted: 04/18/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To develop a strategy to assess the quality of neonatal transport based on change in neonatal condition during transport. STUDY DESIGN The Canadian Transport Risk Index of Physiologic Stability (TRIPS) score was optimized for a California (Ca) population using data collected on 21 279 acute neonatal transports, 2007 to 2009, using models predicting (2/3) and validating (1/3) mortality within 7 days of transport. Quality Change Point 10th percentile (QCP10), a benchmark of the greatest deterioration seen in 10% of the transports by top-performing teams, was established. RESULT Compared with perinatal variables (0.79), the Ca-TRIPS had a validation receiver operator characteristic area for prediction of death of 0.88 in all infants and 0.86 in infants transported after day 7. The risk of death increased 2.4-fold in infants whose deterioration exceeded the QCP10. CONCLUSION We present a practical, benchmarked, risk-adjusted, estimate of the quality of neonatal transport.
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Noninvasive Monitoring during Interhospital Transport of Newborn Infants. Crit Care Res Pract 2013; 2013:632474. [PMID: 23509618 PMCID: PMC3595700 DOI: 10.1155/2013/632474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/04/2013] [Accepted: 01/08/2013] [Indexed: 11/17/2022] Open
Abstract
The main indications for interhospital neonatal transports are radiographic studies (e.g., magnet resonance imaging) and surgical interventions. Specialized neonatal transport teams need to be skilled in patient care, communication, and equipment management and extensively trained in resuscitation, stabilization, and transport of critically ill infants. However, there is increasing evidence that clinical assessment of heart rate, color, or chest wall movements is imprecise and can be misleading even in experienced hands. The aim of the paper was to review the current evidence on clinical monitoring equipment during interhospital neonatal transport.
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Whitfield M, Chessex P. The need for public involvement when operating a regionalized neonatal care system at maximum capacity. Paediatr Child Health 2011; 15:573-5. [PMID: 22043137 DOI: 10.1093/pch/15.9.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2009] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Whitfield
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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13
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Lebel V, Alderson M, Aita M. La stabilité physiologique : analyse d'un concept. Rech Soins Infirm 2011. [DOI: 10.3917/rsi.104.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chang ASM, Berry A, Sivasangari S. Specialty teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
This article reviews the components that facilitate an effective neonatal emergency transport network, and discusses the human resources required for safe transport, including a section focused on the option of an expanded role for the paramedic. In addition, the topics of transport equipment, communications, quality assurance, data management, family support and education are addressed in the context of a neonatal transport programme. Finally, elements involved in the organization of neonatal transport and transport issues pertaining to networking of neonatal medical care are highlighted and illustrated with reference to local experience in British Columbia.
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Affiliation(s)
- Brian A Lupton
- Children's and Women's Health Centre of British Columbia, Division of Neonatology, Room 1R11, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
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Lee SK, McMillan DD, Ohlsson A, Boulton J, Lee DS, Ting S, Liston R. The benefit of preterm birth at tertiary care centers is related to gestational age. Am J Obstet Gynecol 2003; 188:617-22. [PMID: 12634630 DOI: 10.1067/mob.2003.139] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the relationship between gestational age and outcomes of outborn versus inborn preterm infants. STUDY DESIGN Multivariable logistic regression analysis was used to examine gestational age-specific, risk-adjusted outcomes of 2962 singleton infants who were born at <32 weeks of gestation who were admitted to 17 Canadian neonatal intensive care units from 1996 through 1997. RESULTS The risk-adjusted incidence was significantly (P <.05) higher among outborn versus inborn infants for mortality rates (odds ratio, 2.2) and > or =grade 3 intraventricular hemorrhage (odds ratio, 2.1) at < or =26 weeks of gestation and for chronic lung disease (odds ratio, 1.7) at 27 to 29 weeks of gestation. Outcomes of outborn and inborn infants at 30 to 31 weeks of gestation were not significantly different. CONCLUSION The short-term benefit of preterm birth at tertiary centers is related inversely to gestational age and may not extend beyond 29 weeks of gestation.
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Affiliation(s)
- Shoo K Lee
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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