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Abou Mehrem A, Toye J, Beltempo M, Aziz K, Bizgu V, Wong J, Singhal N, Shah PS. Process and Outcome Measures for Infants Born Moderate and Late Preterm in Tertiary Canadian Neonatal Intensive Care Units. J Pediatr 2024; 269:113976. [PMID: 38401787 DOI: 10.1016/j.jpeds.2024.113976] [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] [Received: 11/10/2023] [Revised: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To describe the prevalence of and between-center variations in care practices and clinical outcomes of moderate and late preterm infants (MLPIs) admitted to tertiary Canadian neonatal intensive care units (NICUs). STUDY DESIGN This was a retrospective cohort study including infants born at 320/7 through 366/7 weeks of gestation and admitted to 25 NICUs participating in the Canadian Neonatal Network between 2015 and 2020. Patient characteristics, process measures represented by care practices, and outcome measures represented by clinical in-hospital and discharge outcomes were reported by gestational age weeks. NICUs were compared using indirect standardization after adjustment for patient characteristics. RESULTS Among 25 669 infants (17% of MLPIs born in Canada during the study period) included, 45% received deferred cord clamping, 7% had admission hypothermia, 47% received noninvasive respiratory support, 11% received mechanical ventilation, 8% received surfactant, 40% received antibiotics in the first 3 days, 4% did not receive feeding in the first 2 days, and 77% had vascular access. Mortality, early-onset sepsis, late-onset sepsis, or necrotizing enterocolitis occurred in <1% of the study cohort. Median (IQR) length of stay was 14 (9-21) days among infants discharged home from the admission hospital and 5 (3-9) days among infants transferred to community hospitals. Among infants discharged home, 33% were discharged on exclusive breastmilk and 75% on any breastmilk. There were significant variations between NICUs in all process and outcome measures. CONCLUSIONS Care practices and outcomes of MLPIs varied significantly between Canadian NICUs. Standardization of process and outcome quality measures for this population will enable benchmarking and research, facilitating systemwide improvements.
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Affiliation(s)
- Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - Jennifer Toye
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marc Beltempo
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Khalid Aziz
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Victoria Bizgu
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jonathan Wong
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Nishida T, Kusuda S, Mori R, Toyoshima K, Mitsuhashi H, Sasaki H, Yonemoto N, Kono Y, Uchiyama A, Fujimura M. Impact of comprehensive quality improvement program on outcomes in very-low-birth-weight infants: A cluster-randomized controlled trial in Japan. Early Hum Dev 2024; 190:105947. [PMID: 38295559 DOI: 10.1016/j.earlhumdev.2024.105947] [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] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Differences in outcomes among neonatal intensive care units (NICUs) in Japan have been noted, prompting the need for quality improvement. AIM To assess a comprehensive quality improvement program on outcomes in very-low-birth-weight (VLBW) infants. STUDY DESIGN A cluster-randomized clinical trial. SUBJECTS Forty hospitals and VLBW infants born in 2012-2014 and admitted to those hospitals were study subjects. OUTCOME MEASURES The intervention group (IG) received a comprehensive quality improvement program involving clinical practice guidelines, educational outreach visits, workshops, opinion leader training, audits, and feedback. The control group (CG) was provided only with the guidelines. The primary outcome was survival without neurological impairment at three years of age. RESULTS IG consisted of 19 hospitals and 1735 infants, while CG included 21 hospitals and 1700 infants. There were no significant differences in gestational weeks, 29.1(26.9-31.3) vs. 29.1(26.7-31.1) or birth weights (g), 1054(789-1298) vs. 1084(810-1309) between the two groups. Both groups showed survival rates without neurological impairment of 67.2 % (1166) and 66.9 % (1137), respectively, without a significant difference. There was no significant difference in mortalities at NICU discharge between the groups, with rates of 4.0 % (70) and 4.2 % (72) respectively. Several clinically relevant improvements were observed in IG, including reduced rates of sepsis, adrenal insufficiency, transfusion for anemia, and a shorter interval to achieve full enteral feeding. However, these did not lead to improvements in the primary outcome. CONCLUSION The comprehensive quality improvement program to Japanese NICUs did not result in a significant improvement in survival without neurological impairment in VLBW infants.
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Affiliation(s)
- Toshihiko Nishida
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Pediatrics, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, Japan; Neonatal Research Network of Japan, 3-7-1 Nishishinjuku, Shinjuku, Tokyo, Japan.
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan; Graduate School of Medicine, Kyoto University, Yoshidakonoecho, Sakyoku, Kyoto, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Hospital, 2-138-4 Mutsugawa, Minami, Kanagawa, Japan
| | - Hideko Mitsuhashi
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan
| | - Hatoko Sasaki
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Health Policy, National Center for Child Health and Development, 2-10-1 Ookura, Setagaya, Tokyo, Japan; Shizuoka Graduate University of Public Health, 4-27-2 Kita Ando, Aoi, Shizuoka, Japan
| | - Naohiro Yonemoto
- Department of Public Health, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - Atsushi Uchiyama
- Department of Neonatology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku, Tokyo, Japan; Department of Pediatrics, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Masanori Fujimura
- Department of Neonatology, Osaka Women's and Children's Hospital, 840 Murodocho, Izumi, Osaka, Japan
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