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Shipley LJ, Sharkey D. Quantifying the impact of centralised neonatal care following interhospital transfer of preterm infants on families. Acta Paediatr 2024; 113:2212-2215. [PMID: 39412949 DOI: 10.1111/apa.17334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/07/2024] [Accepted: 06/14/2024] [Indexed: 10/18/2024]
Abstract
AIM Evaluate the additional burden of centralised neonatal care on families of extremely preterm infants cared for away from their planned hospital of birth. METHODS Retrospective cohort study using national data for infants 23+0 to 27+6 weeks of gestation admitted for neonatal care from 2011 to 2016. The number of transfers on the first day of life (potential maternal-infant separation), time away from the maternal booking hospital (BH) and distance from the maternal residence were quantified. RESULTS Of 14 719 included infants, 2803 (19%) underwent postnatal transfer on the first day of life. A total of 8622 (59%) infants were cared for away from their BH for a median of 39 days (interquartile range [IQR] 15-69), 30% spending >60 days away over a median of two episodes (range 1-12). Median return road travelling distances for parents to their local BH was 13 km (IQR 8-26), but this increased to 74 km (IQR 32-148) for those cared for in a non-BH. CONCLUSION Centralised neonatal care improves infant outcomes but introduces additional burdens on the families of extremely preterm infants cared for away from their BH. Additional support, including accommodation and financial aid, could help minimise the impact on these families, facilitate family integrated care and improve parental wellbeing.
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Affiliation(s)
- Lara J Shipley
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
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Gadsbøll C, Björklund LJ, Norman M, Abrahamsson T, Domellöf M, Elfvin A, Farooqi A, Hellström-Westas L, Håkansson S, Källén K, Normann E, Serenius F, Sävman K, Um-Bergström P, Ådén U, Ley D. Centralisation of extremely preterm births and decreased early postnatal mortality in Sweden, 2004-2007 versus 2014-2016. Acta Paediatr 2024. [PMID: 39313908 DOI: 10.1111/apa.17429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024]
Abstract
AIM We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity. METHODS Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004-2007 and 2014-2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes. RESULTS Among 1626 liveborn infants, 703 were born in 2004-2007 and 923 in 2014-2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31-3.07, p = 0.001). The higher 1-year mortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3-4 than inborn infants (22% vs. 14% in 2004-2007, and 22% vs. 13% in 2014-2016, both p < 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%-40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88). CONCLUSION Centralisation of EPT births contributed to a lower 1-year mortality in 2014-2016 than that in 2004-2007, attributed to a decrease in deaths before 24 h among inborn infants.
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Affiliation(s)
- Christian Gadsbøll
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Lars J Björklund
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Abrahamsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Crown Princess Victoria Children's Hospital, Linköping, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aijaz Farooqi
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | | | - Stellan Håkansson
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Karin Källén
- Institution of Clinical Sciences, Department of Obstetrics and Gynecology, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
| | - Erik Normann
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Fredrik Serenius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petra Um-Bergström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Crown Princess Victoria Children's Hospital, Linköping, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David Ley
- Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
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Odd D, Reeve NF, Barnett J, Cutter J, Daniel R, Gale C, Siasakos D. PRECIOUS study (PREterm Caesarean/vaginal birth and IVH/OUtcomeS): does mode of birth reduce the risk of death or brain injury in very preterm babies? A cohort and emulated target trial protocol. BMJ Open 2024; 14:e089722. [PMID: 39260866 PMCID: PMC11409379 DOI: 10.1136/bmjopen-2024-089722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Very preterm babies are at risk of poor neurodevelopmental outcomes and death. Intraventricular haemorrhage (IVH) after birth is the most prevalent cause of this. Birth by caesarean section may protect against IVH in very preterm babies, but the evidence is limited. The aim is to identify and obtain the quantitative evidence needed to inform a future definitive clinical trial to determine the optimal mode of delivery in preterm birth. METHODS AND ANALYSIS We will use three broad workstreams (WS) to answer complementary questions. WSs 1 and 2 involve the analysis of routinely recorded national clinical data held in an established research database. In WS1 (October 2023-March 2024), we will use conventional methods to identify what is needed to undertake a trial: the population of interest, areas of equipoise and a plausible range of effect sizes. In WS2 (April 2024-October 2024), using an emulated target trial framework, we will attempt to make inferences about the treatment effect from such a future trial and will identify potential challenges in recruitment and estimate likely 'intention-to-treat' versus 'per-protocol' profiles; these analyses will also be useful for power calculations for future possible trials. In WS3 (October 2024-March 2025), we will convene a consensus meeting with key stakeholders, supported by a clinical trials unit, to develop a multicentre clinical trial to identify the optimal mode of birth for preterm deliveries. ETHICS AND DISSEMINATION In this study, we will use deidentified data held in the National Neonatal Research Database (NNRD), an established national population database; parents can opt out of their baby's data being held in the NNRD. HRA/Health and Care Research Wales and National Health Service (NHS) study-specific Research Ethics Committee approval (London-Queen Square Research Ethics Committee) (Ref: 23/LO/0826) ethical approval has been obtained. Key outputs of the PRECIOUS (PREterm Caesarean/vaginal birth and IVH/OUutcomeS) study include the identification of the data, and accordingly of the multidisciplinary team required, to develop, gain funding and complete, a clinical trial to definitively identify the optimal mode of delivery for preterm infants and their mothers.
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Affiliation(s)
- David Odd
- University Hospital of Wales, Cardiff, UK
| | | | | | - Judith Cutter
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, UK
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Anumba D, Soma-Pillay P, Bianchi A, Valencia González CM, Jacobbson B. FIGO good practice recommendations on optimizing models of care for the prevention and mitigation of preterm birth. Int J Gynaecol Obstet 2024; 166:1006-1013. [PMID: 39045669 DOI: 10.1002/ijgo.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/25/2024]
Abstract
The global challenge of preterm birth persists with little or no progress being made to reduce its prevalence or mitigate its consequences, especially in low-resource settings where health systems are less well developed. Improved delivery of respectful person-centered care employing effective care models delivered by skilled healthcare professionals is essential for addressing these needs. These FIGO good practice recommendations provide an overview of the evidence regarding the effectiveness of the various care models for preventing and managing preterm birth across global contexts. We also highlight that continuity of care within existing, context-appropriate care models (such as midwifery-led care and group care), in primary as well as secondary care, is pivotal to delivering high quality care across the pregnancy continuum-prior to conception, through pregnancy and birth, and preparation for a subsequent pregnancy-to improve care to prevent and manage preterm birth.
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Affiliation(s)
- Dilly Anumba
- Division of Clinical Medicine, School of Medicine and Population Health, Faculty of Health, University of Sheffield, Sheffield, UK
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynecology, University of Pretoria, Pretoria, South Africa
- Steve Biko Academic Hospital, Pretoria, South Africa
| | - Ana Bianchi
- Perinatal Department, Pereira Rossell Hospital Public Health, Montevideo, Uruguay
| | | | - Bo Jacobbson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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Shahroor M, Whyte-Lewis A, Mak W, Liriano B, Jasani B, Lee KS. Compliance with the Golden Hour bundle in deliveries attended by a specialized neonatal transport team compared with staff at non-tertiary centres. Paediatr Child Health 2024; 29:292-299. [PMID: 39281364 PMCID: PMC11398947 DOI: 10.1093/pch/pxad052] [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: 08/03/2022] [Accepted: 06/23/2023] [Indexed: 09/18/2024] Open
Abstract
Background Preterm infants born at <32 weeks gestational age (GA) have increased morbidity if they are born outside tertiary centres (outborn). Stabilization and resuscitation after birth consistent with the neonatal Golden Hour practices (NGHP) are required to optimize outcomes. Objectives To evaluate physiological outcomes of hypothermia and hypoglycaemia, and compliance with NGHP by neonatal transport team (NTT) compared with referral hospital team (RHT) during the stabilization of infants born at <32 weeks GA. Methods A retrospective case-control study of infants born at <32 weeks GA during 2016-2019 at non-tertiary perinatal centres where the NTT attended the delivery (cases) were matched to infants where the RHT team attended the delivery (controls). Results During the 4-year period, NTT team received 437 requests to attend deliveries at <32 weeks GA and attended 76 (17%) prior to delivery. These cases were matched 1:1 with controls composed of deliveries attended by the RHT. The rate of hypothermia was 15% versus 29% in the NTT and RHT groups, respectively (P = 0.01). The rate of hypoglycaemia (<2.2 mmol/L) was 5% versus 12% in the NTT and RHT groups, respectively (P = 0.64). For compliance with the NGHP, use of fluid boluses was 8% versus 33%, use of thermoregulation practices, that is, plastic bag, was 76% versus 21%, and establishment of intravenous access was 20 min versus 47 min, in the NTT and RHT groups, respectively. Conclusions High-risk preterm deliveries attended by the NTT compared with the RHT had increased compliance and earlier implementation of the NGHP elements, associated with improved physiological stability and lower hypothermia rates. Outreach education for RHT should ensure that these key elements are included during the training in the stabilization of high-risk preterm deliveries.
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Affiliation(s)
- Maher Shahroor
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, Department of Pediatrics, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Andrew Whyte-Lewis
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy Mak
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bridget Liriano
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bonny Jasani
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Balog V, Lantos L, Valek A, Jermendy A, Somogyvari Z, Belteki G. Stabilization, respiratory care and survival of extremely low birth weight infants transferred on the first day of life. J Perinatol 2024:10.1038/s41372-024-02043-w. [PMID: 38969826 DOI: 10.1038/s41372-024-02043-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To assess stabilization, respiratory care and survival of extremely low birth weight (ELBW, <1000 g at birth) infants requiring emergency transfer to tertiary NICUs on the first day of life. STUDY DESIGN Retrospective cohort study of 55 ELBW infants transported by a dedicated neonatal transport service over a 65-month period. Ventilator data were downloaded computationally. RESULTS 95% of infants were intubated and received surfactant prior to transfer. Median expired tidal volume was 5.0 mL/kg (interquartile range: 4.6-6.2 mL/kg). Infants ventilated with SIPPV had significantly higher mean airway pressure and minute ventilation, but similar FiO2 compared to babies on SIMV. Blood gases showed significant improvement during transport. 55% of infants survived to discharge from NICU. CONCLUSION Most ELBW infants transferred on the first day of life require mechanical ventilation and can be ventilated with 5 mL/kg tidal volume.
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Affiliation(s)
- Vera Balog
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Lajos Lantos
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - Andrea Valek
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Agnes Jermendy
- Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Zsolt Somogyvari
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - Gusztav Belteki
- Neonatal Intensive Care Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Pier T, Misuraca JS, Mandt MJ. Vibratory Impact of 3 Different Ambulance Suspension Systems on the Simulated Neonate and Health Care Provider During Normal Driving Conditions. Air Med J 2024; 43:133-139. [PMID: 38490776 DOI: 10.1016/j.amj.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/15/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Patients and health care providers experience varying degrees of vibration during interfacility ground transport. The impact of vibration on term and preterm neonates may result in physiologic instability and increased risk of intracranial hemorrhage, whereas the impact on health care providers has been shown to include an increase in perceived and physiologic stress levels and may contribute to chronic back and neck pain. This study aimed to evaluate 3 common ambulance suspension systems and the corresponding vibratory impact produced during typical interfacility driving conditions on adult caregiver and neonatal patient mannequins. METHODS Type 3 ambulances with air, liquid, and traditional suspensions were evaluated using various driving tests to simulate typical road conditions. Vibrations were measured using triaxial accelerometers placed on the chassis, upon the head of a seated caregiver mannequin in the ambulance bench seat, and the head of a neonatal mannequin supine and secured in an isolette. Data analysis included the average vibration frequency, root mean square values, and maximum vibration amplitudes. RESULTS The results showed that the supine neonatal mannequin experienced the highest vibration frequency and amplitude in the vertical (x) direction, whereas the adult caregiver mannequin experienced higher vibration frequencies in both parallel (y) and lateral (z) directions and the highest vibration amplitude in the y direction. The liquid suspension system consistently demonstrated the lowest vibration levels in all driving conditions and directions, whereas traditional suspension had the highest values. CONCLUSION This study provides important insights into the vibrations incurred by simulated neonatal patients and health care providers during ambulance transport. The directional vibration frequency and amplitude differ between a neonatal mannequin and an adult mannequin when placed in typical positions with typical restraints during varied ambulance driving conditions. In all directional movements and driving conditions, a liquid suspension system decreases vibration frequency and amplitude more than air or traditional systems. The live patient and caregiver impact of these results should be further investigated.
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Affiliation(s)
- Trevor Pier
- Denver Department of Bioengineering, University of Colorado Denver, The Center for Bioengineering, Aurora, CO
| | - Justin S Misuraca
- Department of Nursing, Children's Hospital Colorado Flight Program, Aurora, CO
| | - Maria J Mandt
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
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Wu CL, Chen CH, Chang JH, Peng CC, Hsu CH, Lin CY, Jim WT, Chang HY. The effect of patient volume on mortality and morbidity of extremely low birth weight infants in Taiwan. J Formos Med Assoc 2023; 122:1199-1207. [PMID: 37286420 DOI: 10.1016/j.jfma.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND To assess whether the number of extremely low birth weight (ELBW) infants treated annually in neonatal intensive care units (NICUs) in Taiwan affects the mortality and morbidity of this patient population. METHODS This retrospective cohort study included preterm infants with ELBW (≤1000 g). NICUs were divided into three subgroups according to the annual admissions of ELBW infants (low, ≤10; medium, 11-25; and high, >25). Perinatal characteristics, mortality, and short-term morbidities were compared between groups. RESULTS A total of 1945 ELBW infants from 17 NICUs were analyzed (low-volume, n = 263; medium-volume, n = 420; and high-volume, n = 1262). After risk adjustments, infants from NICUs with low patient volumes were at a higher risk of death. The risk-adjusted odds ratios (aOR) for mortality were 0.61 (95% CI, 0.43-0.86) in the high-volume NICUs and 0.65 (95% CI, 0.43-0.98) in medium-volume NICUs, compared with infants admitted to low-volume NICUs. Infants in medium-volume NICUs had the lowest incidence of prenatal steroid exposure (58.1%, P < 0.001) and were associated with the highest risk of necrotizing enterocolitis (aOR, 2.35 [95% CI, 1.48-3.72]), severe intraventricular hemorrhage (aOR, 1.55 [95% CI, 1.01-2.28]), and bronchopulmonary dysplasia (aOR, 1.61 [95% CI, 1.10-2.35]). However, survival without major morbidity did not differ between the groups. CONCLUSION The mortality risk was higher among ELBW infants admitted to NICUs with a low annual patient volume. This may emphasize the importance of systematically referring patients from these vulnerable populations to appropriate care settings.
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Affiliation(s)
- Chia-Ling Wu
- Branch for Women and Children, Taipei City Hospital, Taipei, Taiwan; Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Chia-Huei Chen
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chun-Chih Peng
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chyong-Hsin Hsu
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Chia-Ying Lin
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Wai-Tim Jim
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hung-Yang Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
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Hurt L, Odd D, Mann M, Beetham H, Dorgeat E, Isaac TC, Ashman A, Wood F. What matters to families about the healthcare of preterm or low birth weight infants: A qualitative evidence synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107893. [PMID: 37473603 DOI: 10.1016/j.pec.2023.107893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE We examined what matters to families about the healthcare provided to preterm or LBW infants in hospital and the community, to ensure that care meets the needs of infants and parents. METHODS We searched databases to identify eligible studies examining the views and expectations of families. Study quality was assessed using the CASP checklist for qualitative studies. The GRADE-CERQual approach was used to assess confidence in review findings. Studies were sampled and data analysed using thematic synthesis. RESULTS 222 studies (227 papers) were eligible for inclusion. 54 studies (57 papers) were sampled based on data richness, methodological quality, and representation across settings. Eight analytical themes were identified. Confidence in results was moderate to high. What mattered was a positive outcome for the child; active involvement in care; being supported to cope at home after discharge; emotional support; the healthcare environment; information needs met; logistical support available; and positive relationships with staff. CONCLUSION Although parents and family members reported a variety of experiences in the care of their infant, we found high consistency in what matters to families. PRACTICE IMPLICATIONS This review identifies approaches to improve experiences of parents which are consistent with the Family Centred Care model of healthcare.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.
| | - David Odd
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | | | - Emma Dorgeat
- Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Fiona Wood
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
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Porta R, García-Muñoz Rodrigo F, Avila-Alvarez A, Ventura PS, Izquierdo Renau M, Ginovart G. Active approach in delivery room and survival of infants born between 22 and 26 gestational weeks are increasing in Spain. Acta Paediatr 2023; 112:417-423. [PMID: 36515614 DOI: 10.1111/apa.16625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
AIM To describe the trends in the delivery room approach and survival of extremely premature infants over the past two decades. METHODS Time-series analysis of infants included in the Spanish SEN1500 network from 2004 to 2019. Patients born from 22 + 0 to 26 + 6 weeks were included. The primary outcome was an active approach in the delivery room. Survival and temporal trends were also studied. RESULTS The study population included 8284 patients. At 22 and 23 weeks, an active approach was followed in 41.4% and 80.8%. A temporal trend toward a more active approach was observed at 23 weeks. Antenatal steroids were administered in 19.6% and 58.1% at 22 and 23 weeks. From 24 weeks, an active approach was applied in nearly all cases throughout the period, and more than 80% of patients received antenatal steroids. The rates of survival after an active approach were 8.7%, 21.6%, 40.6%, 59.9%, and 74.7% at 22, 23, 24, 25, and 26 weeks and significantly increased over the period, except for infants born at 22 weeks. CONCLUSION Active management and survival of infants born from 23 weeks increased over the period, but the frequency of antenatal steroid administration was lower than the intention to resuscitate.
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Affiliation(s)
- Roser Porta
- Division of Neonatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alejandro Avila-Alvarez
- Division of Neonatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Paula Sol Ventura
- Division of Neonatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Gemma Ginovart
- Division of Neonatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Harrison C, Hurley A. In-utero transfers: Why is it such a difficult call to make? Acta Paediatr 2023; 112:432-433. [PMID: 36479718 DOI: 10.1111/apa.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Catherine Harrison
- Embrace Transport Service, Sheffield Childrens Hospital, Sheffield, UK.,Paediatric and neonatal transport team (Embrace), Barnsley, UK
| | - Aoife Hurley
- Embrace Transport Service, Sheffield Childrens Hospital, Sheffield, UK
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12
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Salazar EG, Handley SC, Greenberg LT, Edwards EM, Lorch SA. Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants. JAMA Pediatr 2023; 177:278-285. [PMID: 36648939 PMCID: PMC9857785 DOI: 10.1001/jamapediatrics.2022.5213] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/18/2022] [Indexed: 01/18/2023]
Abstract
Importance A higher level of care improves outcomes in extremely and very preterm infants, yet the impact of neonatal intensive care unit (NICU) level on moderate and late preterm (MLP) care quality is unknown. Objective To examine the association between NICU type and care quality in MLP (30-36 weeks' gestation) and extremely and very preterm (25-29 weeks' gestation) infants. Design, Setting, and Participants This cohort study was a prospective analysis of 433 814 premature infants born in 465 US hospitals between January 1, 2016, and December 31, 2020, without anomalies and who survived more than 12 hours and were transferred no more than once. Data were from the Vermont Oxford Network all NICU admissions database. Exposures NICU types were defined as units with ventilation restrictions without surgery (type A with restrictions, similar to American Academy of Pediatrics [AAP] level 2 NICUs), without surgery (type A) and with surgery not requiring cardiac bypass (type B, similar to AAP level 3 NICUs), and with all surgery (type C, similar to AAP level 4 NICUs). Main Outcomes and Measures The primary outcome was gestational age (GA)-specific composite quality measures using Baby-Measure of Neonatal Intensive Care Outcomes Research (Baby-MONITOR) for extremely and very preterm infants and an adapted MLP quality measure for MLP infants. Secondary outcomes were individual component measures of each scale. Composite scores were standardized observed minus expected scores, adjusted for patient characteristics, averaged, and expressed with a mean of 0 and SD of 1. Between May 2021 and October 2022, Kruskal-Wallis tests were used to compare scores by NICU type. Results Among the 376 219 MLP (204 181 [54.3%] male, 172 038 [45.7%] female; mean [SD] GA, 34.2 [1.7] weeks) and 57 595 extremely and very preterm (30 173 [52.4%] male, 27 422 [47.6%] female; mean [SD] GA, 27.7 [1.4] weeks) infants included, 6.6% received care in type A NICUs with restrictions, 29.3% in type A NICUs without restrictions, 39.7% in type B NICUs, and 24.4% in type C NICUs. The MLP infants had lower MLP-QM scores in type C NICUs (median [IQR]: type A with restrictions, 0.4 [-0.1 to 0.8]; type A, 0.4 [-0.4 to 0.9]; type B, 0.1 [-0.7 to 0.7]; type C, -0.7 [-1.6 to 0.4]; P < .001). No significant differences were found in extremely and very preterm Baby-MONITOR scores by NICU type. In type C NICUs, MLP infants had lower scores in no extreme length of stay and change-in-weight z score. Conclusions and Relevance In this cohort study, composite quality scores were lower for MLP infants in type C NICUs, whereas extremely and very preterm composite quality scores were similar across NICU types. Policies facilitating care for MLP infants at NICUs with less complex subspecialty services may improve care quality delivered to this prevalent, at-risk population.
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Affiliation(s)
- Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Lucy T. Greenberg
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, The University of Vermont, Burlington
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, Vermont
- Department of Mathematics and Statistics, The University of Vermont, Burlington
- Department of Pediatrics, The Robert Larner, MD College of Medicine, The University of Vermont, Burlington
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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13
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Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120:3-23. [PMID: 36863329 PMCID: PMC10064400 DOI: 10.1159/000528914] [Citation(s) in RCA: 147] [Impact Index Per Article: 147.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023]
Abstract
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).
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Affiliation(s)
- David G. Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
| | - Virgilio P. Carnielli
- Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C. Roehr
- Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christian P. Speer
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerry H.A. Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L. Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
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14
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Lantos L, Széll A, Chong D, Somogyvári Z, Belteki G. Acceleration during neonatal transport and its impact on mechanical ventilation. Arch Dis Child Fetal Neonatal Ed 2023; 108:38-44. [PMID: 35705324 DOI: 10.1136/archdischild-2021-323498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE During interhospital transfer, critically ill neonates frequently require mechanical ventilation and are exposed to physical forces related to movement of the ambulance. In an observational study, we investigated acceleration during emergency transfers and if they result from changes in ambulance speed and direction or from vibration due to road conditions. We also studied how these forces impact on performance of the fabian+nCPAP evolution neonatal ventilator and on patient-ventilator interactions. METHODS We downloaded ventilator parameters at 125 Hz and acceleration data at 100 Hz sampling rates, respectively, during the emergency transfer of 109 infants. Study subjects included term, preterm and extremely preterm infants. We computationally analysed the magnitude, direction and frequency of ambulance acceleration. We also analysed maintenance and variability of ventilator parameters and the shape of pressure-volume loops. RESULTS While acceleration was <1 m/s2 most of the time, most babies were occasionally exposed to accelerations>5 m/s2. Vibration was responsible for most of the acceleration, rather than speed change or vehicle turning. There was no significant difference between periods of high or low vibration in ventilation parameters, their variability and how well targeted parameters were kept close to their target. Speed change or vehicle turning did not affect ventilator parameters or performance. However, during periods of intense vibration, pressure-volume ventilator loops became significantly more irregular. CONCLUSIONS Infants are exposed to significant acceleration and vibration during emergency transport. While these forces do not interfere with overall maintenance of ventilator parameters, they make the pressure-volume loops more irregular.
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Affiliation(s)
- Lajos Lantos
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - András Széll
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - David Chong
- Neonatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zsolt Somogyvári
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary
| | - Gusztav Belteki
- Neonatal Emergency & Transport Services of the Peter Cerny Foundation, Budapest, Hungary .,Neonatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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15
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Stern V, Jones GL, Senbeto S, Anumba D. The acceptability of cervical electrical impedance spectroscopy within a multi-modal preterm birth screening package: a mixed methods study. BMC Pregnancy Childbirth 2022; 22:959. [PMID: 36550429 PMCID: PMC9783720 DOI: 10.1186/s12884-022-05202-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Reducing the rate of preterm birth is a cornerstone of global efforts to address child mortality, however existing screening tests offer imperfect prediction. Cervical electrical impedance spectroscopy (EIS) is a novel technique to quantify the ripening changes which precede labour. Mid-trimester EIS measurements have been shown to accurately predict preterm birth in asymptomatic women. This study aimed to comprehensively evaluate the acceptability of cervical EIS to low and high-risk women as part of a package of screening tests performed during a larger prospective trial. METHODS In this parallel convergent mixed methods study, 40 women completed questionnaires before and after screening tests (EIS, cervical length measurement and fetal fibronectin quantification). Quantitative outcomes were anxiety levels before and after screening (Spielberger State Trait Anxiety Inventory, STAI-6), pain (Short Form McGill Pain Questionnaire) and ratings of EIS device appearance and test acceptability (visual analogue scales). Twenty-one women (11 high-risk, 10 low-risk) also attended a semi-structured qualitative interview. Interviews were recorded and transcribed, then thematic analysis was performed. A convergence coding matrix was constructed to enable triangulation of quantitative and qualitative results. RESULTS High risk women demonstrated a significant reduction in anxiety following screening (mean STAI-6 score 34.5 vs. 29.0, p = 0.002). A similar trend was observed among low-risk participants. Ratings of pain, EIS device appearance and procedural acceptability did not differ between groups. Mean pain ratings were low (visual analogue scale 0.97 and 1.01), comparing favourably to published evaluations of conventional screening tests. Qualitative analysis provided insight into both the physical consequences and emotional experiences of screening. Additional determinants of the screening experience included device design, pre-existing perspectives on intimate examination, attitudes to knowledge in pregnancy and interaction with clinical staff. Finally, a range of practical considerations regarding wider use of EIS were identified, with valuable complementary detail regarding acceptability for use in antenatal care. CONCLUSIONS Cervical EIS is well tolerated and acceptable to both low and high-risk women when performed as part of a multi-modal screening package. These results provide useful insights to inform the design of future study and screening protocols.
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Affiliation(s)
- Victoria Stern
- grid.11835.3e0000 0004 1936 9262Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Georgina L. Jones
- grid.10346.300000 0001 0745 8880School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Sarah Senbeto
- grid.31410.370000 0000 9422 8284Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dilly Anumba
- grid.11835.3e0000 0004 1936 9262Academic Unit of Reproductive and Developmental Medicine, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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16
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Jones P, Marchand-Martin L, Desplanches T, Diguisto C, Fresson J, Goffinet F, Dauger S, Ancel PY, Morgan AS. Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001619. [PMID: 36645784 PMCID: PMC9756224 DOI: 10.1136/bmjpo-2022-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/29/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for. DESIGN Individual matched study nested within a prospective cohort. Each outborn infant was matched using GA and antenatal steroids with a maximum of four inborns. Conditional logistic regression was used to calculate ORs before being adjusted using maternal and birth characteristics. Analyses were carried out after multiple imputation for missing data. SETTING EPIPAGE-2 French national prospective cohort including births up to 34 weeks GA inclusive. PATIENTS Outborn and inborn control infants selected between 24 and 31 weeks GA were followed in the neonatal period and to 2 and 5.5 years. 3335 infants were eligible of whom all 498 outborns and 1235 inborn infants were included-equivalent to 2.5 inborns for each outborn. MAIN OUTCOME MEASURE Survival without moderate-to-severe neurodevelopmental impairment at 5.5 years. RESULTS Chorioamnionitis, pre-eclampsia, caesarian birth and small-for-dates were more frequent among inborns, and spontaneous labour and antepartum haemorrhage among outborns. There was no difference in the main outcome measure at 5.5 years of age (adjusted OR 1.09, 95% CI 0.82 to 1.44); sensitivity analyses suggested improved outcomes at lower GAs for inborns. CONCLUSION In this GA and steroid matched cohort, there was no difference in survival without moderate-to-severe neurodevelopmental impairment to 5.5 years of age between inborn and outborn very preterm children. This suggests steroids might be important in determining outcomes.
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Affiliation(s)
- Peter Jones
- SAMU de Paris, Necker-Enfants Malades Hospitals, Paris, France.,Paediatric Intensive Care, Hôpital Robert Debré, Robert-Debré Mother-Child University Hospital Mobile Service of Urgences and Reanimation, Paris, France
| | - Laetitia Marchand-Martin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France
| | - Thomas Desplanches
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon University Hospital, Dijon, France
| | - Caroline Diguisto
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Maternité Olympe de Gouges, CHRU Tours Pôle de Gynécologie Obstétrique Médecine fœtale et Reproduction, Tours, France
| | - Jeanne Fresson
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Population Health Office, DREES, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - François Goffinet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Department of Obstetrics and Gynaecology, Maternité Port-Royal, Association Publique - Hôpitaux de Paris, Paris, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Clinical Investigation Center P1419, APHP, Paris, France
| | - Andrei Scott Morgan
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France .,EGA Institute for Women's Health, UCL, London, UK.,Pôle Femmes-Parents-Enfants, Service de réanimation et médecine néonatale, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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17
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Young A, Cole TJ, Cheng G, Ennis S, Beattie RM, Johnson MJ. Changes in the growth of very preterm infants in England 2006-2018. Arch Dis Child Fetal Neonatal Ed 2022; 108:267-271. [PMID: 36307188 DOI: 10.1136/archdischild-2022-324584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare weight gain from birth to term equivalent age in very preterm infants in England born during two eras (2006-2011 and 2014-2018); to assess demographic and care factors influencing weight gain. METHODS Data for infants born before 32 weeks of gestation during 2014-2018 in England were obtained (29 687 infants). Weight gain modelled using SuperImposition by Translation And Rotation (SITAR), with infants grouped by gestational week. A cohort from 2006 to 2011 was used for comparison (3288 infants). Multiple linear regression was used to assess factors influencing change in weight SD score from birth to 36 weeks postmenstrual age. RESULTS Weight gain velocity (termed 'intensity' in SITAR models) was greater in the more recent cohort for all gestation groups born before 30 weeks of gestation. After adjustment for gestation, birth weight and other perinatal factors, care elements associated with faster weight gain included delivery in a level 3 unit (0.09 SD less weight gain deficit, 95% CI: 0.07 to 0.10) and parenteral nutrition initiation during the first day of life (0.08 SD, 95% CI: 0.06 to 0.10). Factors associated with slower weight gain included early ventilation (-0.07 SD, 95% CI: -0.08 to -0.05) and less deprived neighbourhood (-0.012 SD per Index of Multiple Deprivation decile, 95% CI: -0.015 to -0.009). CONCLUSIONS Weight gain for extremely preterm infants was faster during 2014-2018 than during 2006-2011. Early initiation of parenteral nutrition and birth in a level 3 unit may contribute to faster weight gain.
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Affiliation(s)
- Aneurin Young
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK .,NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Tim J Cole
- Population Policy and Practice Programme, UCL, London, UK
| | - Guo Cheng
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Sarah Ennis
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- NIHR Southampton Biomedical Research Centre, Southampton, UK.,Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark John Johnson
- Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Southampton, UK
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18
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Cho IY, Lee HM, Kim SY, Kim ES. Impact of Outborn/Inborn Birth Status of Infants Born at <29 Weeks of Gestation on Neurodevelopmental Impairment: A Nationwide Cohort Study in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11718. [PMID: 36141991 PMCID: PMC9517045 DOI: 10.3390/ijerph191811718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
This study designed to evaluate the short- and long-term outcomes of outborn and inborn preterm infants enhancing the regional perinatal system in South Korea. It is a prospective cohort study of the Korean neonatal network database for infants born at <29 weeks of gestation between 2013 and 2015. Of 2995 eligible infants, 312 were outborn, and 976 completed the assessment of long-term outcome at 18-24 months of corrected age. The mean gestational age was significantly younger in outborn infants than in inborn infants (p = 0.004). The mean Apgar score at 5 min was higher in inborn infants (p = 0.046). More inborn preterm infants died before discharge (p < 0.001); however, most of the other short-term outcomes occurred significantly more often in outborn infants than in inborn infants. The outborn infants had higher odds of neurodevelopmental impairment (adjusted odds ratio (aOR) 2.412, 95% confidence interval (CI) 1.585-3.670), cerebral palsy (aOR 4.460, 95% CI 2.249-8.845) and developmental impairment (aOR 2.238, 95% CI 1.469-3.408). In preterm infants, the location of birth may be a key factor influencing short- and long-term outcomes. Thus, to provide adequate care and efficiently allocate medical resources to high-risk preterm infants, nationwide regional perinatal systems need to be improved and standardized.
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Affiliation(s)
- In Young Cho
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Hye Mi Lee
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Sae Yun Kim
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Eun Sun Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon 24341, Korea
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19
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Massirio P, De Paolis FM, Calevo MG, Cardiello V, Andreato C, Minghetti D, Piccardo E, Ramenghi LA, Bellini C. Intubation Rate Evaluation of Inborn Versus Outborn Premature Newborns Affected by Respiratory Distress Syndrome: Impact of Neonatal Transport. Air Med J 2022; 41:346-349. [PMID: 35750440 DOI: 10.1016/j.amj.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to compare the management of preterm newborns with respiratory distress both in the delivery room and during transportation. METHODS We retrospectively evaluated the intubation rate in preterm newborns (inborn vs. outborn), gestational age (GA) < 34 weeks, admitted to the Gaslini neonatal intensive care unit, Genoa, Italy (January 2019-December 2020). RESULTS A total of 251 newborns were included (202 inborn and 49 outborn). The intubation rate was significantly higher in outborn newborns (69.4% vs. 42.1%, P = .001) in the GA 30- to 34- week subgroup (63.2% vs 20.6%, P = .001) but not in the GA < 30-week subgroup (90.9% vs. 81.7%, P = .68). CONCLUSION Although the medical staff members involved in neonatal transport were the same who work both in the neonatal intensive care unit and the delivery room, we found a significantly higher intubation rate in outborn newborns, probably due to the transport itself. It is fundamental to encourage in utero transportation to reduce the risk linked to invasive ventilation due to neonatal transportation.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Francesca-Maria De Paolis
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Maria Grazia Calevo
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Valentina Cardiello
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Chiara Andreato
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Elvia Piccardo
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy
| | - Carlo Bellini
- Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, Department Mother and Child, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini Hospital, Genoa, Italy.
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20
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Neonatal acute kidney injury risk stratification score: STARZ study. Pediatr Res 2022; 91:1141-1148. [PMID: 34012029 DOI: 10.1038/s41390-021-01573-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures. METHODS The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]. RESULTS The neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%. CONCLUSIONS The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. IMPACT The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment. With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population.
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21
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Usuda H, Carter S, Takahashi T, Newnham JP, Fee EL, Jobe AH, Kemp MW. Perinatal care for the extremely preterm infant. Semin Fetal Neonatal Med 2022; 27:101334. [PMID: 35577715 DOI: 10.1016/j.siny.2022.101334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Being born preterm (prior to 37 weeks of completed gestation) is a leading cause of childhood death up to five years of age, and is responsible for the demise of around one million preterm infants each year. Rates of prematurity, which range from approximately 5 to 18% of births, are increasing in most countries. Babies born extremely preterm (less than 28 weeks' gestation) and in particular, in the periviable (200/7-256/7 weeks) period, are at the highest risk of death, or the development of long-term disabilities. The perinatal care of extremely preterm infants and their mothers raises a number of clinical, technical, and ethical challenges. Focusing on 'micropremmies', or those born in the periviable period, this paper provides an update regarding the aetiology and impacts of periviable preterm birth, advances in the antenatal, intrapartum, and acute post-natal management of these infants, and a review of counselling/support approaches for engaging with the infant's family. It concludes with an overview of emerging technology that may assist in improving outcomes for this at-risk population.
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Affiliation(s)
- Haruo Usuda
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - Sean Carter
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Tsukasa Takahashi
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - John P Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Erin L Fee
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Alan H Jobe
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Perinatal Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Matthew W Kemp
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore; School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, 6150, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan.
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22
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Shipley L, Hyliger G, Sharkey D. Temporal trends of in utero and early postnatal transfer of extremely preterm infants between 2011 and 2016: a UK population study. Arch Dis Child Fetal Neonatal Ed 2022; 107:201-205. [PMID: 34281936 DOI: 10.1136/archdischild-2021-322195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Early postnatal transfer (PNT) of extremely preterm infants is associated with adverse outcomes compared with in utero transfer (IUT). We aimed to explore recent national trends of IUT and early PNT. DESIGN Observational cohort study using the National Neonatal Research Database. SETTING Neonatal units in England, Scotland and Wales. PATIENTS Extremely preterm infants 23+0-27+6 weeks' gestation admitted for neonatal care from 2011 to 2016. MAIN OUTCOME The incidence of IUT or PNT within 72 hours of life. Secondary outcomes included mortality, hospital transfer level between centres and temporal changes across two equal epochs, 2011-2013 (epoch 1 (Ep1)) and 2014-2016 (epoch 2 (Ep2)). RESULTS 14 719 infants were included (Ep1=7363 and Ep2=7256); 4005 (27%) underwent IUT; and 3042 (20.7%) had PNT. IUTs decreased significantly between epochs from 28.3% (Ep1=2089) to 26.0% (Ep2=1916) (OR 0.90, 95% CI 0.84 to 0.97, p<0.01). Conversely, PNTs increased from 19.8% (Ep1=1416) to 21.5% (Ep2=1581) (OR 1.11, 95% CI 1.02 to 1.20, p=0.01). PNTs between intensive care centres increased from 8.1% (Ep1=119) to 10.2% (Ep2=161, p=0.05). Mortality decreased from 21.6% (Ep1=1592) to 19.3% (Ep2=1421) (OR 0.90, 95% CI 0.83 to 0.97, p=0.01). Survival to 90 days of age was significantly lower in infants undergoing PNT compared with IUT (HR 1.31, 95% CI 1.18 to 1.46), with the greatest differences observed in infants <25 weeks' gestational age. CONCLUSION In the UK, IUT of extremely preterm infants has significantly decreased over the study period with a parallel increase in early PNT. Strategies to reverse these trends, improve IUT pathways and optimise antenatal steroid use could significantly improve survival and reduce brain injury for these high-risk infants.
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Affiliation(s)
- Lara Shipley
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian Hyliger
- Neonatal Intensive Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Don Sharkey
- Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
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23
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Marlow N, Adams E, David AL. Refining regional organization of services in the UK to improve outcomes of pregnancies delivering at extremely low gestational age. Semin Perinatol 2022; 46:151534. [PMID: 34879981 DOI: 10.1016/j.semperi.2021.151534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Care for pregnant women and their infants at extremely low gestational ages challenges clinical teams. The continuing rise in survival at gestational ages below 25 weeks has prompted re-evaluation of practice guidelines within the UK and other countries. This paper describes the background data that have guided our practice, the approach that has been taken to deliver optimal outcomes for pregnancies delivering at extremely low gestational age in the UK, mainly through centralising care, and discusses the research and audit data that support our practice. In particular, we emphasize the importance of a coordinated perinatal approach to both mother and infant, and careful assessment of the risks to both, to ensure that we develop the highest quality personalized care for each family, supported by national quality improvement and research evidence.
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Affiliation(s)
- Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, UK.
| | - Eleri Adams
- Getting it Right First Tim (GIRFT) Clinical Lead for Neonatology and Consultant Neonatologist, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anna L David
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, 74 Huntley Street, London WC1E 6AU, UK
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24
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Long-term outcomes of children with neonatal transfer: the Japan Environment and Children's Study. Eur J Pediatr 2022; 181:2501-2511. [PMID: 35333975 PMCID: PMC9889501 DOI: 10.1007/s00431-022-04450-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/09/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children's Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19-1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07-1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03-1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12-1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26-1.83). Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known: • Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes. • Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New: • This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment. • Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.
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25
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Liebers B, Ebenebe CU, Wolf M, Blohm ME, Vettorazzi E, Singer D, Deindl P. Improved Less Invasive Surfactant Administration Success in Preterm Infants after Procedure Standardization. CHILDREN 2021; 8:children8121145. [PMID: 34943341 PMCID: PMC8700472 DOI: 10.3390/children8121145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
Less invasive surfactant administration (LISA) has been introduced at our tertiary Level IV perinatal center since 2016 with an unsatisfactory success rate, which we attributed to an inconsistent, non-standardized approach and ambiguous patient inclusion criteria. This study aimed to improve the LISA success rate to at least 75% within 12 months by implementing a highly standardized LISA approach combined with team training. The Plan Do Study Act method of quality improvement was used for this initiative. Baseline assessment included a review of patient medical records 12 months before the intervention regarding patient characteristics, method success rate, respiratory, and adverse outcomes. A multi-professional team developed a standardized LISA approach and a training program including an educational film, checklists, pocket cards, and team briefings. Twenty-one preterm infants received LISA before and 24 after the intervention. The mean LISA success rate improved from 62% before the intervention to 92% (p = 0.029) after the intervention. Implementing a highly standardized LISA approach and multi-professional team training significantly improved the methods’ success rate.
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Affiliation(s)
- Björn Liebers
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany; (B.L.); (C.U.E.); (M.W.); (M.E.B.); (D.S.)
| | - Chinedu Ulrich Ebenebe
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany; (B.L.); (C.U.E.); (M.W.); (M.E.B.); (D.S.)
| | - Monika Wolf
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany; (B.L.); (C.U.E.); (M.W.); (M.E.B.); (D.S.)
| | - Martin Ernst Blohm
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany; (B.L.); (C.U.E.); (M.W.); (M.E.B.); (D.S.)
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany;
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany; (B.L.); (C.U.E.); (M.W.); (M.E.B.); (D.S.)
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, 20240 Hamburg, Germany; (B.L.); (C.U.E.); (M.W.); (M.E.B.); (D.S.)
- Correspondence: ; Tel.: +49-(0)-152-22817959
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26
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Boland RA, Cheong JLY, Doyle LW. Changes in long-term survival and neurodevelopmental disability in infants born extremely preterm in the post-surfactant era. Semin Perinatol 2021; 45:151479. [PMID: 34493405 DOI: 10.1016/j.semperi.2021.151479] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Extremely preterm birth before 28 weeks' gestation accounts for less than 1% of births in high-income countries but is associated with high rates of perinatal and infant mortality, and of neurodevelopmental disability in surviving children. Survival rates have increased over time, both overall, and within each week of gestational age since the introduction of exogenous surfactant into clinical care in the early 1990s. However, rates of major neurodevelopmental disability in survivors, whether they be in early childhood or at school-age, have not clearly improved in parallel with the increases in survival. An important strategy to improve survival free of major neurodevelopmental disability is to birth extremely preterm infants in a tertiary perinatal center, where specialist obstetric care for the mother and ongoing intensive care for the infant can both be provided without the potential morbidities associated with postnatal transfer.
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Affiliation(s)
- Rosemarie A Boland
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Neonatal Services, Royal Women's Hospital, Parkville, VIC, Australia
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27
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Desplanches T, Morgan AS, Jones P, Diguisto C, Zeitlin J, Martin-Marchand L, Benhammou V, Lecomte B, Rozé JC, Truffert P, Ancel PY, Sagot P, Roussot A, Fresson J, Blondel B. Risk factors for very preterm delivery out of a level III maternity unit: The EPIPAGE-2 cohort study. Paediatr Perinat Epidemiol 2021; 35:694-705. [PMID: 33956996 DOI: 10.1111/ppe.12770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regionalisation programmes aim to ensure that very preterm infants are born in level III units (inborn) through antenatal referral or transfer. Despite widespread knowledge about better survival without disability for inborn babies, 10%-30% of women deliver outside these units (outborn). OBJECTIVE To investigate risk factors associated with outborn deliveries and to estimate the proportion that were probably or possibly avoidable. METHODS We used a national French population-based cohort including 2205 women who delivered between 24 and 30+6 weeks in 2011. We examined risk factors for outborn delivery related to medical complications, antenatal care, sociodemographic characteristics and living far from a level III unit using multivariable binomial regression. Avoidable outborn deliveries were defined by pregnancy risk (obstetric history, antenatal hospitalisation) and time available for transfer. RESULTS 25.0% of women were initially booked in level III, 9.1% were referred, 49.8% were transferred, and 16.1% had outborn delivery. Risk factors for outborn delivery were gestational age <26 weeks (adjusted relative risk (aRR) 1.37, 95% confidence interval (CI) 1.13, 1.66), inadequate antenatal care (aRR 1.39, 95% CI 1.10, 1.81), placental abruption (aRR 1.66, 95% CI 1.27, 2.17), and increased distance to the closest level III unit ((aRR 2.79, 95% CI 2.00, 3.92) in the 4th versus 1st distance quartile). Among outborn deliveries, 16.7% were probably avoidable, and 25.6% possibly avoidable, which could increase the proportion of inborn deliveries between 85.9% and 92.9%. Avoidable outborn deliveries were mainly associated with gestational age, intrauterine growth restriction, preterm premature rupture of membranes, and haemorrhage, but not distance. CONCLUSIONS Our study identified some modifiable risk factors for outborn delivery; however, when regionalised care relies heavily on antenatal transfer, as it does in France, only some outborn deliveries may be prevented. Earlier referral of high-risk women will be needed to achieve full access to tertiary care.
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Affiliation(s)
- Thomas Desplanches
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Andrei S Morgan
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, UCL, London, UK.,Embrace Yorkshire and Humber Infant and Paediatric Transport Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Peter Jones
- SAMU de Paris, AP-HP, Hôpital Necker Enfants Malades, Paris, France.,Réanimation Pédiatrique AP-HP, Hôpital Robert Debré, Paris, France
| | - Caroline Diguisto
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Obstetrics and Gynecology, University Hospital of Tours, Tours University, Tours, France
| | - Jennifer Zeitlin
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Laetitia Martin-Marchand
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | - Valérie Benhammou
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
| | | | - Jean-Christophe Rozé
- Pediatric Intensive Care Unit, Mothers' and Children's Hospital, Nantes Teaching Hospital, Nantes, France
| | - Patrick Truffert
- Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France
| | - Paul Sagot
- CHRU Dijon, Department of Gynaecology, Obstetrics, Foetal Medicine and Infertility, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Jeanne Fresson
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - Béatrice Blondel
- Obstetrical, Perinatal, and Pediatric Epidemiology Team, Center of Research in Epidemiology and Statistics (U1153), Université de Paris, INSERM, Paris, France
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28
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Kadambari S, Trotter CL, Heath PT, Goldacre MJ, Pollard AJ, Goldacre R. Group B Streptococcal Disease in England (1998 - 2017): A Population-based Observational Study. Clin Infect Dis 2021; 72:e791-e798. [PMID: 32989454 DOI: 10.1093/cid/ciaa1485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Group B Streptococcus (GBS) is the leading cause of sepsis and meningitis in infants <90 days. In this study, the burden of GBS disease and mortality in young infants in England was assessed. METHODS Using linked hospitalization records from every National Health Service (NHS) hospital from April 1, 1998 to March 31, 2017, we calculated annual GBS incidence in infants aged <90 days and, using regression models, compared their perinatal factors, rates of hospital-recorded disease outcomes, and all-cause infant mortality rates with those of the general infant population. RESULTS 15 429 infants aged <90 days had a hospital-recorded diagnosis of GBS, giving an average annual incidence of 1.28 per 1000 live births (95% CI 1.26-1.30) with no significant trend over time. GBS-attributable mortality declined significantly from 0.044 (95% CI .029-.065) per 1000 live births in 2001 to 0.014 (95% CI .010-.026) in 2017 (annual percentage change -6.6, 95% CI -9.1 to -4.0). Infants with GBS had higher relative rates of visual impairment (HR 7.0 95% CI 4.1-12.1), cerebral palsy (HR 9.3 95% CI 6.6-13.3), hydrocephalus (HR 17.3 95% CI 13.8-21.6), and necrotizing enterocolitis (HR 18.8 95% CI 16.7-21.2) compared with those without GBS. CONCLUSIONS Annual rates of GBS disease in infants have not changed over 19 years. The reduction in mortality is likely multifactorial and due to widespread implementation of antibiotics in at-risk mothers and babies, as well as advances in managing acutely unwell infants. New methods for prevention, such as maternal vaccination, must be prioritized.
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Affiliation(s)
- Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group & Vaccine Institute, St George's, University of London, and St George's University Hospitals NHS Trust, London, United Kingdom
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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29
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Chang YS, Liang FW, Lin YJ, Lu TH, Lin CH. Neonatal and infant mortality of very-low-birth-weight infants in Taiwan: Does the level of delivery hospital matter? Pediatr Neonatol 2021; 62:419-427. [PMID: 34020899 DOI: 10.1016/j.pedneo.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/31/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To study the distribution of the birthplaces of very-low-birth-weight (VLBW) infants and examine whether delivery at different levels of hospital affects neonatal and infant mortality. METHODS This population-based cohort study was retrieved from Taiwan Maternal and Child Health Database. Livebirth singleton VLBW infants born between 2011 and 2014, with BW between 500 and 1499 g and gestational age ≥22 weeks were enrolled. The main outcomes were risk-adjusted odds ratios (aOR) of neonatal and infant mortality by birthplace, which was categorized as medical center (MC), regional hospital (RH), district hospital (DH), and clinic (C) based on Taiwan's hospital accreditation system. RESULTS Of 4560 VLBW infants enrolled, 3005 (66%) were born in MCs, 1181 (26%) in RHs, 213 (5%) in DHs, and 161 (4%) in Cs. Neonatal mortality rates were 10%, 15%, 16%, 17%, and infant mortality rates were 13%, 17%, 18%, 21%, if born in MCs, RHs, DHs and Cs, respectively. The aORs for neonatal and infant mortality were 1.94 (95% CI 1.53-2.48) and 1.67 (1.34-2.08) for those born in RHs, 2.26 (1.38-3.70) and 1.82 (1.16-2.86) for infants born in DHs/Cs, as compared to those born in MCs. For VLBW infants born in RHs, DHs, and Cs and postnatally transferred to MCs, the aORs of neonatal and infant mortality were lower than those who were not transferred. CONCLUSION VLBW infants born outside of MCs had higher neonatal and infant mortality and a two-fold higher risk of mortality than those born in MCs. When possible, VLBW infants should be born in MCs.
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Affiliation(s)
- Yu-Shan Chang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yuh-Jyh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan; Department of Pediatrics, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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30
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Stock SJ, Horne M, Bruijn M, White H, Boyd KA, Heggie R, Wotherspoon L, Aucott L, Morris RK, Dorling J, Jackson L, Chandiramani M, David AL, Khalil A, Shennan A, van Baaren GJ, Hodgetts-Morton V, Lavender T, Schuit E, Harper-Clarke S, Mol BW, Riley RD, Norman JE, Norrie J. Development and validation of a risk prediction model of preterm birth for women with preterm labour symptoms (the QUIDS study): A prospective cohort study and individual participant data meta-analysis. PLoS Med 2021; 18:e1003686. [PMID: 34228732 PMCID: PMC8259998 DOI: 10.1371/journal.pmed.1003686] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Timely interventions in women presenting with preterm labour can substantially improve health outcomes for preterm babies. However, establishing such a diagnosis is very challenging, as signs and symptoms of preterm labour are common and can be nonspecific. We aimed to develop and externally validate a risk prediction model using concentration of vaginal fluid fetal fibronectin (quantitative fFN), in combination with clinical risk factors, for the prediction of spontaneous preterm birth and assessed its cost-effectiveness. METHODS AND FINDINGS Pregnant women included in the analyses were 22+0 to 34+6 weeks gestation with signs and symptoms of preterm labour. The primary outcome was spontaneous preterm birth within 7 days of quantitative fFN test. The risk prediction model was developed and internally validated in an individual participant data (IPD) meta-analysis of 5 European prospective cohort studies (2009 to 2016; 1,783 women; mean age 29.7 years; median BMI 24.8 kg/m2; 67.6% White; 11.7% smokers; 51.8% nulliparous; 10.4% with multiple pregnancy; 139 [7.8%] with spontaneous preterm birth within 7 days). The model was then externally validated in a prospective cohort study in 26 United Kingdom centres (2016 to 2018; 2,924 women; mean age 28.2 years; median BMI 25.4 kg/m2; 88.2% White; 21% smokers; 35.2% nulliparous; 3.5% with multiple pregnancy; 85 [2.9%] with spontaneous preterm birth within 7 days). The developed risk prediction model for spontaneous preterm birth within 7 days included quantitative fFN, current smoking, not White ethnicity, nulliparity, and multiple pregnancy. After internal validation, the optimism adjusted area under the curve was 0.89 (95% CI 0.86 to 0.92), and the optimism adjusted Nagelkerke R2 was 35% (95% CI 33% to 37%). On external validation in the prospective UK cohort population, the area under the curve was 0.89 (95% CI 0.84 to 0.94), and Nagelkerke R2 of 36% (95% CI: 34% to 38%). Recalibration of the model's intercept was required to ensure overall calibration-in-the-large. A calibration curve suggested close agreement between predicted and observed risks in the range of predictions 0% to 10%, but some miscalibration (underprediction) at higher risks (slope 1.24 (95% CI 1.23 to 1.26)). Despite any miscalibration, the net benefit of the model was higher than "treat all" or "treat none" strategies for thresholds up to about 15% risk. The economic analysis found the prognostic model was cost effective, compared to using qualitative fFN, at a threshold for hospital admission and treatment of ≥2% risk of preterm birth within 7 days. Study limitations include the limited number of participants who are not White and levels of missing data for certain variables in the development dataset. CONCLUSIONS In this study, we found that a risk prediction model including vaginal fFN concentration and clinical risk factors showed promising performance in the prediction of spontaneous preterm birth within 7 days of test and has potential to inform management decisions for women with threatened preterm labour. Further evaluation of the risk prediction model in clinical practice is required to determine whether the risk prediction model improves clinical outcomes if used in practice. TRIAL REGISTRATION The study was approved by the West of Scotland Research Ethics Committee (16/WS/0068). The study was registered with ISRCTN Registry (ISRCTN 41598423) and NIHR Portfolio (CPMS: 31277).
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Affiliation(s)
- Sarah J. Stock
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
- * E-mail:
| | - Margaret Horne
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
| | - Merel Bruijn
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
| | - Helen White
- Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Kathleen A. Boyd
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Robert Heggie
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Lisa Wotherspoon
- MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, United Kingdom
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Rachel K. Morris
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Jon Dorling
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Anna L. David
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, United Kingdom
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom
| | - Andrew Shennan
- Department of Women and Children’s Health, School of Life Course Sciences, Kings College London, United Kingdom
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Tina Lavender
- Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Ewoud Schuit
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Ben W. Mol
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Richard D. Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, United Kingdom
| | - Jane E. Norman
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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31
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Lorthe E, Benhammou V, Marchand-Martin L, Pierrat V, Lebeaux C, Durox M, Goffinet F, Kaminski M, Ancel PY. Cohort Profile: The Etude Epidémiologique sur les Petits Ages Gestationnels-2 (EPIPAGE-2) preterm birth cohort. Int J Epidemiol 2021; 50:1428-1429m. [PMID: 34165536 PMCID: PMC8580281 DOI: 10.1093/ije/dyaa282] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/16/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Elsa Lorthe
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
- Corresponding author. Inserm U1153, Maternité Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France. E-mail:
| | - Valérie Benhammou
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
| | - Laetitia Marchand-Martin
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
| | - Véronique Pierrat
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Cécile Lebeaux
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
- Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Ile de France, France
- Reseau Perinatal, Val de Marne, Ile-de-France, France
| | - Mélanie Durox
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
| | - François Goffinet
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
- Maternité Port-Royal, AP-HP, APHP.Centre - Université de Paris, FHU PREMA, Paris, France
| | - Monique Kaminski
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team [EPOPé]), INRA, F-75004 Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, APHP.CUP, F-75014, Paris, France
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32
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Lorch SA, Rogowski J, Profit J, Phibbs CS. Access to risk-appropriate hospital care and disparities in neonatal outcomes in racial/ethnic groups and rural-urban populations. Semin Perinatol 2021; 45:151409. [PMID: 33931237 PMCID: PMC8184635 DOI: 10.1016/j.semperi.2021.151409] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Variations in infant and neonatal mortality continue to persist in the United States and in other countries based on both socio-demographic characteristics, such as race and ethnicity, and geographic location. One potential driver of these differences is variations in access to risk-appropriate delivery care. The purpose of this article is to present the importance of delivery hospitals on neonatal outcomes, discuss variation in access to these hospitals for high-risk infants and their mothers, and to provide insight into drivers for differences in access to high-quality perinatal care using the available literature. This review also illustrates the lack of information on a number of topics that are crucial to the development of evidence-based interventions to improve access to appropriate delivery hospital services and thus optimize the outcomes of high-risk mothers and their newborns.
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Affiliation(s)
- Scott A. Lorch
- Children's Hospital of Philadelphia, Division of Neonatology,Perelman School of Medicine, University of Pennsylvania
| | | | - Jochen Profit
- Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal Medicine
| | - Ciaran S. Phibbs
- Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal Medicine,Veterans Affairs Palo Alto Health Care System
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33
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DiLabio J, Zwicker JG, Sherlock R, Daspal S, Shah PS, Shah V. Maternal age and long-term neurodevelopmental outcomes of preterm infants < 29 weeks gestational age. J Perinatol 2021; 41:1304-1312. [PMID: 32694856 DOI: 10.1038/s41372-020-0735-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to assess the impact of maternal age on neurodevelopmental (ND) outcomes of infants < 29 weeks gestational age (GA) at 18-24 months. STUDY DESIGN A retrospective cohort study of preterm infants < 29 weeks GA admitted to Canadian tertiary NICUs was performed. The primary outcome was a composite of death or ND impairment (NDI)/significant NDI (sNDI) at 18-24 months. Association between maternal age and outcome was assessed across maternal age groups (15-19, 20-34, 35-39 and ≥40 years) using logistic regression after adjusting for confounders. RESULTS Of 3691 eligible infants, 2652 with complete data were included in the analysis. Significant differences in maternal characteristics existed across age groups. The only difference in neonatal characteristics was the incidence of bronchopulmonary dysplasia (p < 0.01). There was no association between maternal age and death or NDI/sNDI after controlling for confounders. CONCLUSION Maternal age is not associated with differences in NDI/sNDI rates among Canadian preterm infants < 29 weeks GA.
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Affiliation(s)
- Julia DiLabio
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jill G Zwicker
- Department of Occupational Science & Occupational Therapy and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rebecca Sherlock
- Division of Neonatology, Surrey Memorial Hospital, Surrey, BC, Canada
| | - Sibasis Daspal
- Division of Neonatology, Royal University Hospital, Saskatoon, SK, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Vibhuti Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
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European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161:291-326. [PMID: 33773829 DOI: 10.1016/j.resuscitation.2021.02.014] [Citation(s) in RCA: 237] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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35
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Hirata K, Kimura T, Hirano S, Wada K, Kusuda S, Fujimura M. Outcomes of outborn very-low-birth-weight infants in Japan. Arch Dis Child Fetal Neonatal Ed 2021; 106:131-136. [PMID: 32788390 DOI: 10.1136/archdischild-2019-318594] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Outcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain. OBJECTIVE To compare morbidity and mortality between outborn and inborn VLBWIs. DESIGN Observational cohort study using inverse-probability-of-treatment weighting. SETTING Neonatal Research Network of Japan. PATIENTS Singleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016. METHODS Inverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality. RESULTS The full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4-31.0) weeks and 1128 (862-1351) g for outborns and 28.7 (26.3-30.9) weeks and 1042 (758-1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality. CONCLUSION Outborn delivery of VLBWIs was associated with an increased risk of severe IVH.
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Affiliation(s)
- Katsuya Hirata
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Takeshi Kimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinya Hirano
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Kazuko Wada
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | | | - Masanori Fujimura
- Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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36
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Morgan AS, Waheed S, Gajree S, Marlow N, David AL. Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study. Sci Rep 2021; 11:288. [PMID: 33431902 PMCID: PMC7801674 DOI: 10.1038/s41598-020-79445-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Delivery at extreme preterm gestational ages (GA) [Formula: see text] weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks' GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.
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Affiliation(s)
- Andrei S Morgan
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la Chine, 75020, Paris, France.,SAMU 93-SMUR Pédiatrique, CHI André Gregoire, Groupe Hospitalier Universitaire Paris Seine-Saint-Denis, Assistance Publique des Hôpitaux de Paris, Montreuil, France.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Saadia Waheed
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Shivani Gajree
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK
| | - Neil Marlow
- Research Department of Neonatology, Elizabeth Garrett Anderson Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.,Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK
| | - Anna L David
- Women's Health Division, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK. .,NIHR University College London Hospitals BRC, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK. .,Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, 2nd floor, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
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37
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Tan AHK, Shand AW, Marsney RL, Schindler T, Bolisetty S, Guaran R, Cruz M, Chow SSW, Lui K. When should intensive care be provided for the extremely preterm infants born at the margin of viability? A survey of Australasian parents and clinicians. J Paediatr Child Health 2021; 57:52-57. [PMID: 32808379 DOI: 10.1111/jpc.15115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to explore clinician and parent opinions of risk limits on resuscitation and intensive care (IC) for extremely premature infants born at the margin of viability. METHODS Two anonymous on-line surveys were conducted from August 2016 to January 2017. Survey participants were: (i) clinicians affiliated with neonatal intensive care units in Australia; and (ii) parents or individuals who expressed interest in premature babies through the Facebook page of Miracle Babies Foundation. RESULTS A total of 961 responses were received. Among 204 clinicians, 52% were neonatologists, 22% obstetricians, 20% neonatal intensive care unit nurses and 4% were midwives. Among 757 parents, 98% had a premature baby. Only 75% of clinicians responded to the risk limits questions. Median mortality risk above which they would not recommend resuscitation/IC was 70% (interquartile range (IQR) 50-80%); major disability risk in survivors 60% (IQR 50-75%); and composite risk of mortality and major disability 70% (IQR 50-80%). All parents answered the risk limit questions. The median mortality risk for not planning resuscitation was 90% (IQR 60-90%); major disability risk in survivors 50% (IQR 30-90%); and composite risk 90% (IQR 50-90%). Most clinicians (82%) stated that decisions should be guided by parent opinions if there are uncertainties. Parents had varying perception of previous counselling, and 57% stated that both their viewpoint and doctor's predicted risk influenced their decision-making. CONCLUSIONS Clinicians and parents had different views on mortality and major disability risks when deciding on resuscitation/neonatal IC treatment. When there was uncertainty, both agreed on working together.
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Affiliation(s)
- Alvin H K Tan
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Antonia W Shand
- Department of Maternal and Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,Child Population and Translational Health Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Renate L Marsney
- Australian and New Zealand Neonatal Network (ANZNN), University of New South Wales, Sydney, New South Wales, Australia
| | - Timothy Schindler
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert Guaran
- New South Wales Pregnancy and Newborn Services Network (PSN), Sydney, New South Wales, Australia
| | - Melinda Cruz
- Miracle Babies Foundation, Sydney, New South Wales, Australia
| | - Sharon S W Chow
- Australian and New Zealand Neonatal Network (ANZNN), University of New South Wales, Sydney, New South Wales, Australia
| | - Kei Lui
- Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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38
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Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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39
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Fawke J, Tinnion RJ, Monnelly V, Ainsworth SB, Cusack J, Wyllie J. How does the BAPM Framework for Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation impact delivery of Newborn Life Support? A Resuscitation Council UK response. Arch Dis Child Fetal Neonatal Ed 2020; 105:672-674. [PMID: 32273302 DOI: 10.1136/archdischild-2020-318927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022]
Abstract
In October 2019, the British Association of Perinatal Medicine (BAPM) published a Framework1 and associated infographic2 for 'Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation' This outlined an approach, based on data from the UK and abroad, to assist clinicians in decision-making relating to perinatal care at ≤26+6 weeks gestation. Many frontline providers of delivery room care of extremely preterm infants will have completed a Resuscitation Council UK (RCUK) Newborn Life Support or Advanced Resuscitation of the Newborn Infant course. This RCUK response to the BAPM Framework highlights how this might impact on their approach.
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Affiliation(s)
- Joe Fawke
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK .,Resuscitation Council (UK), London, UK
| | - Robert J Tinnion
- Neonatal Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | - Sean B Ainsworth
- Women and Children's Services, Victoria Hospital, Kirkcaldy, Fife, UK
| | - Jonathan Cusack
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jonathan Wyllie
- Resuscitation Council (UK), London, UK.,Neonatology, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
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40
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Boel L, Banerjee S, Clark M, Greenwood A, Sharma A, Goel N, Bagga G, Poon C, Odd D, Chakraborty M. Temporal trends of care practices, morbidity, and mortality of extremely preterm infants over 10-years in South Wales, UK. Sci Rep 2020; 10:18738. [PMID: 33127999 PMCID: PMC7603316 DOI: 10.1038/s41598-020-75749-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Contemporary outcome data of preterm infants are essential to commission, evaluate and improve healthcare resources and outcomes while also assisting professionals and families in counselling and decision making. We analysed trends in clinical practice, morbidity, and mortality of extremely preterm infants over 10 years in South Wales, UK. This population-based study included live born infants < 28 weeks of gestation in tertiary neonatal units between 01/01/2007 and 31/12/2016. Patient characteristics, clinical practices, mortality, and morbidity were studied until death or discharge home. Temporal trends were examined by adjusted multivariable logistic regression models and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). A sensitivity analysis was conducted after excluding infants born at < 24 weeks of gestation. In this population, overall mortality for infants after live birth was 28.2% (267/948). The odds of mortality (aOR 0.93, 95% CI [0.88, 0.99]) and admission to the neonatal unit (0.93 [0.87, 0.98]) significantly decreased over time. Non-invasive ventilation support during stabilisation at birth increased significantly (1.26 [1.15, 1.38]) with corresponding decrease in mechanical ventilation at birth (0.89 [0.81, 0.97]) and following admission (0.80 [0.68–0.96]). Medical treatment for patent ductus arteriosus significantly decreased over the study period (0.90 [0.85, 0.96]). The incidence of major neonatal morbidities remained stable, except for a reduction in late-onset sepsis (0.94 [0.89, 0.99]). Gestation and centre of birth were significant independent factors for several outcomes. The results from our sensitivity analysis were compatible with our main results with the notable exception of death after admission to NICU (0.95 [0.89, 1.01]). There were significant improvements in survival and reduction of late-onset sepsis of extreme preterm infants in South Wales between 2007 and 2016. The sensitivity analysis suggests that some of the temporal changes observed were driven by improved outcomes in the most preterm of infants. Clinical practices related to respiratory support have changed but significant variations in clinical practices and outcomes between centres remain unexplained. The adoption of regional evidence-based clinical guidelines is likely to improve outcomes and reduce variation.
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Affiliation(s)
- Lieve Boel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Sujoy Banerjee
- Neonatal Intensive Care Unit, Singleton Hospital, Swansea, UK
| | - Megan Clark
- School of Medicine, Cardiff University, Cardiff, UK
| | - Annabel Greenwood
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Alok Sharma
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Nitin Goel
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Gautam Bagga
- Neonatal Intensive Care Unit, Royal Gwent Hospital, Newport, UK
| | - Chuen Poon
- Neonatal Intensive Care Unit, Royal Gwent Hospital, Newport, UK
| | - David Odd
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, CF14 4XW, UK. .,Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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Parvin N, Charlton JR, Baldelomar EJ, Derakhshan JJ, Bennett KM. Mapping vascular and glomerular pathology in a rabbit model of neonatal acute kidney injury using MRI. Anat Rec (Hoboken) 2020; 303:2716-2728. [PMID: 32445514 PMCID: PMC7680718 DOI: 10.1002/ar.24419] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/30/2020] [Accepted: 03/03/2020] [Indexed: 12/27/2022]
Abstract
Acute kidney injury (AKI) in premature neonates is common due to the administration of life-saving therapies. The impact of AKI on renal morphology and susceptibility to further renal damage is poorly understood. Recent advances in radiological imaging have allowed integration of soft tissue morphology in the intact organ, facilitating a more complete understanding of changes in tissue microstructure associated with pathology. Here, we applied magnetic resonance imaging (MRI) to detect both glomerular and vascular changes in a rabbit model of neonatal AKI, induced by indomethacin and gentamicin. Using combined spin-echo MRI and cationic ferritin enhanced gradient-echo MRI (CFE-MRI), we observed (a) an increased cortical arterial diameter in the AKI cohort compared to healthy controls, and (b) focal loss of vascular density and glomerular loss in a circumferential band ~1 mm from the cortical surface. This combined use of vascular and glomerular imaging may give insight into the etiology of AKI and its impact on renal health later in life.
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Affiliation(s)
- Neda Parvin
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jennifer R Charlton
- University of Virginia Children's Hospital, Department of Pediatrics, Charlottesville, Virginia, USA
| | - Edwin J Baldelomar
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jamal J Derakhshan
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin M Bennett
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
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42
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Stanak M. Neonatology in Austria: ethics to improve practice. MEDICINE, HEALTH CARE AND PHILOSOPHY 2020; 23:361-369. [PMID: 32144643 PMCID: PMC7426316 DOI: 10.1007/s11019-020-09943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the world of Austrian neonatal intensive care units, the role of ethics is recognized only partially. The normatively tense cases that are at the backdrop of this essay concern the situations around the limit of viability (weeks 22 + 0 days to 25 + 6 days of gestation), which is the point in the development of an extremely preterm infant at which there are chances of extra-uterine survival. This essay first outlines the key explicit ethical challenges that are mainly concerned with notions of uncertainty and best interest. Then, it attempts to elucidate the less explicit ethical challenges related to the notion of nudging in the neonatal practice and argue that the role of ethics needs to be recognized more—with the focus on the role of virtue ethics—in order to improve the practice of neonatal medicine.
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Watson H, McLaren J, Carlisle N, Ratnavel N, Watts T, Zaima A, Tribe RM, Shennan AH. All the right moves: why in utero transfer is both important for the baby and difficult to achieve and new strategies for change. F1000Res 2020; 9. [PMID: 32913633 PMCID: PMC7429922 DOI: 10.12688/f1000research.25923.1] [Citation(s) in RCA: 11] [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] [Accepted: 08/04/2020] [Indexed: 01/20/2023] Open
Abstract
The best way to ensure that preterm infants benefit from relevant neonatal expertise as soon as they are born is to transfer the mother and baby to an appropriately specialised neonatal facility before birth (“
in utero”). This review explores the evidence surrounding the importance of being born in the right unit, the advantages of
in utero transfers compared to
ex utero transfers, and how to accurately assess which women are at most risk of delivering early and the challenges of
in utero transfers. Accurate identification of the women most at risk of preterm birth is key to prioritising who to transfer antenatally, but the administrative burden and pathway variation of
in utero transfer in the UK are likely to compromise optimal clinical care. Women reported the impact that
in utero transfers have on them, including the emotional and financial burdens of being transferred and the anxiety surrounding domestic and logistical concerns related to being away from home. The final section of the review explores new approaches to reforming the
in utero transfer process, including learning from outside the UK and changing policy and guidelines. Examples of collaborative regional guidance include the recent Pan-London guidance on
in utero transfers. Reforming the transfer process can also be aided through technology, such as utilising the CotFinder app. In utero transfer is an unavoidable aspect of maternity and neonatal care, and the burden will increase if preterm birth rates continue to rise in association with increased rates of multiple pregnancy, advancing maternal age, assisted reproductive technologies, and obstetric interventions. As funding and capacity pressures on health services increase because of the COVID-19 pandemic, better prioritisation and sustained multi-disciplinary commitment are essential to maximise better outcomes for babies born too soon.
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Affiliation(s)
- Helena Watson
- Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - James McLaren
- Gosford Hospital, Gosford, New South Wales, Australia
| | - Naomi Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | - Tim Watts
- Guy's and St Thomas NHS Foundation Trust, London, UK
| | | | - Rachel M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Andrew H Shennan
- Guy's and St Thomas NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Goswami I, Redpath S, Langlois RG, Green JR, Lee KS, Whyte HEA. Whole-body vibration in neonatal transport: a review of current knowledge and future research challenges. Early Hum Dev 2020; 146:105051. [PMID: 32464450 DOI: 10.1016/j.earlhumdev.2020.105051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
Interfacility transport to tertiary care for high-risk neonates has become an integral part of equitable access to optimal perinatal healthcare. Excellence in clinical care requires expertise in transport medicine and the coordination of safe transport processes. However, concerns remain regarding environmental stressors involved in the transportation of sick high-risk neonates, including noise and vibration. In order to mitigate the potential deleterious effects of these physical stressors during transport, further knowledge of the burden of exposure, injury mechanisms and engineering interventions/modifications as adjuncts during transport would be beneficial. We reviewed the current literature with a focus on the contribution of new and emerging technologies in the transport environment with particular reference to whole-body vibration. This review intends to highlight what is known about vibration as a physical stressor in neonates and areas for further research; with the goal to making recommendations for minimizing these stressors during transport.
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Affiliation(s)
- I Goswami
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - S Redpath
- Department of Paediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
| | - R G Langlois
- Department of Mechanical and Aerospace Engineering, Carleton University, Canada
| | - J R Green
- Department of Systems and Computer Engineering, Carleton University, Canada
| | - K S Lee
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - H E A Whyte
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
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45
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Edwards K, Impey L. Extreme preterm birth in the right place: a quality improvement project. Arch Dis Child Fetal Neonatal Ed 2020; 105:445-448. [PMID: 31719143 PMCID: PMC7363788 DOI: 10.1136/archdischild-2019-317741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 12/04/2022]
Abstract
Extreme preterm birth is a major precursor to mortality and disability. Survival is improved in babies born in specialist centres but for multiple reasons this frequently does not occur. In the Thames Valley region of the UK in 2012-2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014-2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction. There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement. The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.
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Affiliation(s)
- Katherine Edwards
- Patient Safety Collaborative, Oxford Academic Health Sciences Network, Oxford, UK
| | - Lawrence Impey
- Department of Fetal Medicine, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
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Goodarzi B, Walker A, Holten L, Schoonmade L, Teunissen P, Schellevis F, de Jonge A. Towards a better understanding of risk selection in maternal and newborn care: A systematic scoping review. PLoS One 2020; 15:e0234252. [PMID: 32511258 PMCID: PMC7279596 DOI: 10.1371/journal.pone.0234252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Globally, millions of women and their children suffer due to preventable morbidity and mortality, associated with both underuse and overuse of maternal and newborn care. An effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity to ensure women and children receive appropriate care, at the right place and the right time. Poor conceptualization of risk selection impedes evaluation and comparison of models of risk selection across various settings, which is necessary to improve maternal and newborn care. We conducted a scoping review to enhance the understanding of risk selection in maternal and newborn care. We included 210 papers, published over the past four decades, originating from 24 countries. Using inductive thematic analysis, we identified three main dimensions of risk selection: (1) risk selection as an organisational measure to optimally align women's and children's needs and resources, (2) risk selection as a practice to detect and assess risk and to make decisions about the delivery of care, and (3) risk selection as a tool to ensure safe care. We found that these three dimensions have three themes in common: risk selection (1) is viewed as both requiring and providing regulation, (2) has a provider centred focus and (3) aims to avoid underuse of care. Due to the methodological challenges of contextual diversity, the concept of risk selection needs clear indicators that capture the complexity of care to make cross-setting evaluation and comparison of risk selection possible. Moreover, a comprehensive understanding of risk selection needs to consider access disparity, women's needs, and unnecessary medicalization.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annika Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lianne Holten
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - François Schellevis
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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47
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Munthali K, Harrison C. The continuing impact of capacity on a region's in utero transfer requests. Acta Paediatr 2020; 109:1148-1153. [PMID: 31630453 DOI: 10.1111/apa.15070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
Abstract
AIM The Yorkshire and Humber operational delivery network (ODN) aims to ensure 85% of preterm babies are delivered in tertiary centres. Auditing in utero transfers provides key data for streamlining this process. Our study aimed to determine reasons and outcomes of in utero transfers as well as review the impact of staffing on capacity transfer requests. METHODS All in utero transfer referrals between September 2014 and August 2015 were reviewed, and delivery outcome data were sought from the national data platform, Badgernet. ODN records provided cot occupancy and staffing data. RESULTS A total of 479 referrals were made, and 379 transfers were completed. The majority of requests were due to reduced capacity which was linked to poor staffing levels (51.3%). Patients travelled significant distances, with a mean distance of 42.3 miles within network, and 70.3 miles, out of network. Despite the travel burden, only 35.1% of women delivered within 48 hours of transfer. CONCLUSION In utero transfers remain difficult and time-consuming to facilitate. Neonatal staffing at referral units contributes significantly to the decision to transfer women. Challenges remain in predicting which women will deliver after an in utero transfer, as well as obtaining outcome data for these cases.
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Affiliation(s)
- Kalwa Munthali
- Connect North West Transport Service St Mary's Hospital Manchester UK
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48
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Bioethical Decisions in Neonatal Intensive Care: Neonatologists' Self-Reported Practices in Greek NICUs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103465. [PMID: 32429230 PMCID: PMC7277706 DOI: 10.3390/ijerph17103465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 01/27/2023]
Abstract
This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to withhold or withdraw neonatal intensive care (p < 0.05). Conclusions: Our research shows that Greek NICU physicians report considerably lower levels of ethical decision-making regarding preterm and ill newborns compared to their counterparts in other European countries. Clinical practices and attitudes towards ethical decision-making appear to be influenced mainly by the Greek physicians’ values.
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49
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Mactier H, Bates SE, Johnston T, Lee-Davey C, Marlow N, Mulley K, Smith LK, To M, Wilkinson D. Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice. Arch Dis Child Fetal Neonatal Ed 2020; 105:232-239. [PMID: 31980443 DOI: 10.1136/archdischild-2019-318402] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Tracey Johnston
- Department of Fetal and Maternal Medicine, Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
| | | | - Lucy K Smith
- Health Sciences, University of Leicester, Leicester, UK
| | - Meekai To
- King's College Hospital NHS Trust, London, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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50
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Do transport factors increase the risk of severe brain injury in outborn infants <33 weeks gestational age? J Perinatol 2020; 40:385-393. [PMID: 31427782 DOI: 10.1038/s41372-019-0447-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We evaluated transport factors and postnatal practices to identify modifiable risk factors for SBI. STUDY DESIGN Retrospective review of Canadian Neonatal Transport Network data linked to Canadian Neonatal Network data for outborns <33 weeks gestational age (GA), during January 2014 to December 2015. SBI was defined as grade 3 or 4 intraventricular hemorrhage or parenchymal echogenicity, including hemorrhagic and/or ischemic lesions. RESULT Among 781 infants, 115 (14.7%) had SBI with range 5.6-40% among transport teams. In multivariable analysis, SBI was associated with GA [0.77 (0.71, 0.85)] per week, receipt of chest compressions and/or epinephrine at delivery [1.81 (1.08, 3.05)] and receipt of fluid boluses [1.61 (1.00, 2.58)]. CONCLUSIONS Risk factors for SBI were related to the condition at birth and immediate postnatal management and not related to transport factors. These results highlight the importance of maternal transfer to perinatal centers to allow optimization of perinatal management.
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