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Hodgson E, Briatico D, Klapman S, Skarsgard E, Beltempo M, Shah PS, Huisman E, Walton JM, Livingston MH. Association of Exclusive Breast Milk Intake and Outcomes in Infants With Uncomplicated Gastroschisis: A National Cohort Study. J Pediatr Surg 2024; 59:863-868. [PMID: 38413262 DOI: 10.1016/j.jpedsurg.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Enteral feeding is an essential part of the management of infants with gastroschisis. We hypothesized that exclusive breast milk is associated with improved neonatal outcomes. METHODS We conducted a retrospective review of infants with uncomplicated gastroschisis through the Canadian Pediatric Surgery Network (CAPSNet) and Canadian Neonatal Network (CNN). The primary outcome was time to full enteral feeds. RESULTS We identified 411 infants with gastroschisis treated at CAPSNet centres from 2014 to 2022. 144 patients were excluded due to gestational age <32 weeks, birth weight <1500 g, other congenital anomalies, or complicated gastroschisis. Of the remaining 267 participants, 78% (n = 209) received exclusive breast milk diet in the first 28 days of life, whereas 22% (n = 58) received supplemental or exclusive formula. Infants who received exclusive breast milk experienced higher time to reach full enteral feeding (median 24 vs 22 days, p = 0.047) but were more likely to have undergone delayed abdominal closure (32% vs 17%, p = 0.03). After adjustment, there were no significant differences between groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay. Infants who received supplemental or exclusive formula had a similar risk of necrotizing enterocolitis (4% vs 3%) but were less likely to transition to exclusive breast milk at discharge (73% vs 11%, p < 0.001). CONCLUSION Early use of exclusive breast milk in infants with uncomplicated gastroschisis is associated with similar outcomes compared to supplemental or exclusive formula. Patients who received supplemental or exclusive formula were unlikely to transition to exclusive breastfeeding by discharge. LEVEL OF EVIDENCE Level IIb (Individual Cohort Study).
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Affiliation(s)
- Emily Hodgson
- Division of General Surgery, McMaster University, Hamilton, Canada
| | - Daniel Briatico
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Sarah Klapman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Erik Skarsgard
- Division of Pediatric Surgery, University of British Columbia, Vancouver, Canada
| | - Marc Beltempo
- Division of Neonatology, McGill University Health Centre, Montreal, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Esther Huisman
- Division of Neonatology, McMaster University, Hamilton, Canada
| | - J Mark Walton
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Canada
| | - Michael H Livingston
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Canada; Division of Pediatric Surgery, McMaster University, Hamilton, Canada.
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Hadj-Youssef S, Rondeau F, Golo KT, Ghali N, Laberge M, Li P, Beltempo M, Lacroix G, Wissanji H. Provincial Review of Adherence to Age-specific Guidelines for Umbilical Hernia Repair and Trends in Management. J Pediatr Surg 2024; 59:791-799. [PMID: 38418272 DOI: 10.1016/j.jpedsurg.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Umbilical hernia (UH) is a common pediatric condition, for which delaying surgical repair for asymptomatic UH until after age 3 is recommended due to a high incidence of spontaneous closure. We aimed to determine the adherence to guidelines, rate of urgent surgical repair, outcomes, cost, and interinstitutional referral patterns of UH repair in the province of Quebec (Canada). METHODS This was a population-based retrospective cohort study of children 28 days to 17 years old who underwent UH repair between 2010 and 2020 using health administrative databases. Children who had multiple procedures, or prolonged peri-operative stays were excluded. Early repair was defined as elective surgery at or under age 3. RESULTS Of the 3215 children, 1744 (54.2%) were female, and 1872 (58.2%) were treated in a tertiary children's hospital. Guidelines were respected for 2853 out of 3215 children (89.7%). Patients living over 75 km from their treating hospitals (OR 2.36, 95% CI 1.33-4.16, P < 0.01), with pre-existing comorbidities (OR, 2.82; 95% CI, 1.96-4.05; P < 0.001), or being treated in a tertiary center (OR 2.10, 95% CI 1.45-3.03, P < 0.001) had a higher risk of early repair. Repair at or under age 3 and urgent surgery were associated with significant cost increases of 411$ (P < 0.001) and 558$ (P < 0.001), respectively. CONCLUSION Quebec has a high rate of adherence to age-specific guidelines for UH repair. Future research should explore factors that explain transfers into tertiary centers, and the extent to which these reflect efficient use of resources. LEVEL OF EVIDENCE level III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Shadi Hadj-Youssef
- School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 3605 Rue de la Montagne, Montréal, QC, Canada
| | - Félix Rondeau
- Department of Economics, Université Laval, Pavillon Charles-De Koninck, 1030 Av. des Sciences Humaines, Québec, QC, Canada
| | - Kossi Thomas Golo
- Ministère de la santé et des services sociaux (MSSS), 1075, chemin Sainte-Foy, Québec City, QC, Canada
| | - Nizar Ghali
- Ministère de la santé et des services sociaux (MSSS), 1075, chemin Sainte-Foy, Québec City, QC, Canada
| | - Maude Laberge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, QC, Canada; Vitam, Centre de recherche en santé durable-Université Laval, Québec, QC, Canada; Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Patricia Li
- Division of General Pediatrics, Department of Pediatrics, McGill University Health Centre - Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University Health Centre - Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Pavillon Charles-De Koninck, 1030 Av. des Sciences Humaines, Québec, QC, Canada
| | - Hussein Wissanji
- Harvey E. Beardmore Division of Pediatric Surgery, Department of Pediatric Surgery, McGill University Health Center, Montreal Children's Hospital, Canada.
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Schmölzer GM, Asztalos EV, Beltempo M, Boix H, Dempsey E, El-Naggar W, Finer NN, Hudson JA, Mukerji A, Law BHY, Yaskina M, Shah PS, Sheta A, Soraisham A, Tarnow-Mordi W, Vento M. Does the use of higher versus lower oxygen concentration improve neurodevelopmental outcomes at 18-24 months in very low birthweight infants? Trials 2024; 25:237. [PMID: 38576007 PMCID: PMC10996184 DOI: 10.1186/s13063-024-08080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Immediately after birth, the oxygen saturation is between 30 and 50%, which then increases to 85-95% within the first 10 min. Over the last 10 years, recommendations regarding the ideal level of the initial fraction of inspired oxygen (FiO2) for resuscitation in preterm infants have changed from 1.0, to room air to low levels of oxygen (< 0.3), up to moderate concentrations (0.3-0.65). This leaves clinicians in a challenging position, and a large multi-center international trial of sufficient sample size that is powered to look at safety outcomes such as mortality and adverse neurodevelopmental outcomes is required to provide the necessary evidence to guide clinical practice with confidence. METHODS An international cluster, cross-over randomized trial of initial FiO2 of 0.3 or 0.6 during neonatal resuscitation in preterm infants at birth to increase survival free of major neurodevelopmental outcomes at 18 and 24 months corrected age will be conducted. Preterm infants born between 230/7 and 286/7 weeks' gestation will be eligible. Each participating hospital will be randomized to either an initial FiO2 concentration of either 0.3 or 0.6 to recruit for up to 12 months' and then crossed over to the other concentration for up to 12 months. The intervention will be initial FiO2 of 0.6, and the comparator will be initial FiO2 of 0.3 during respiratory support in the delivery room. The sample size will be 1200 preterm infants. This will yield 80% power, assuming a type 1 error of 5% to detect a 25% reduction in relative risk of the primary outcome from 35 to 26.5%. The primary outcome will be a composite of all-cause mortality or the presence of a major neurodevelopmental outcome between 18 and 24 months corrected age. Secondary outcomes will include the components of the primary outcome (death, cerebral palsy, major developmental delay involving cognition, speech, visual, or hearing impairment) in addition to neonatal morbidities (severe brain injury, bronchopulmonary dysplasia; and severe retinopathy of prematurity). DISCUSSION The use of supplementary oxygen may be crucial but also potentially detrimental to preterm infants at birth. The HiLo trial is powered for the primary outcome and will address gaps in the evidence due to its pragmatic and inclusive design, targeting all extremely preterm infants. Should 60% initial oxygen concertation increase survival free of major neurodevelopmental outcomes at 18-24 months corrected age, without severe adverse effects, this readily available intervention could be introduced immediately into clinical practice. TRIAL REGISTRATION The trial was registered on January 31, 2019, at ClinicalTrials.gov with the Identifier: NCT03825835.
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Affiliation(s)
- Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
- Dept. of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Elizabeth V Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Marc Beltempo
- Departement of Pediatrics, Montreal Children's HospitalMcGill University Health CenterMcGill University, Montreal, QC, Canada
| | - Hector Boix
- Division of Neonatology, Dexeus Quironsalud University Hospital, Barcelona, Spain
| | - Eugene Dempsey
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Walid El-Naggar
- Department of Paediatrics, Dalhousie University, Halifax, Canada
| | - Neil N Finer
- School of Medicine, University of California, San Diego, CA, USA
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, USA
| | - Jo-Anna Hudson
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Amit Mukerji
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Brenda H Y Law
- Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada
- Dept. of Pediatrics, University of Alberta, Edmonton, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Ayman Sheta
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Amuchou Soraisham
- Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
- Alberta Childrens Hospital Research Institute, University of Calgary, Alberta, Canada
| | - William Tarnow-Mordi
- Trials Centre, National Health and Medical Research Council Clinical, University of Sydney, Camperdown, Australia
| | - Max Vento
- Department of Pediatrics, La Fe University and Polytechnic Hospital, Valencia, Spain
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Debay A, Shah P, Lodha A, Shivananda S, Redpath S, Seshia M, Dorling J, Lapointe A, Canning R, Strueby L, Beltempo M. Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants. Am J Perinatol 2024; 41:747-755. [PMID: 35170012 DOI: 10.1055/a-1772-4637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to assess if 24-hour in-house neonatologist (NN) coverage is associated with delivery room (DR) resuscitation/stabilization and outcomes among inborn infants <29 weeks' gestational age (GA). STUDY DESIGN Survey-linked cohort study of 2,476 inborn infants of 23 to 28 weeks' gestation, admitted between 2014 and 2015 to Canadian Neonatal Network Level-3 neonatal intensive care units (NICUs) with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-hour in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, and retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. RESULTS Among the 28 participating NICUs, most senior providers ensuring 24-hour in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-hour fellow coverage were associated with higher odds of infants receiving DR chest compressions/epinephrine compared with 24-hour NN coverage (adjusted odds ratio [aOR] = 4.72, 95% confidence interval [CI]: 2.12-10.6 and aOR = 3.33, 95% CI: 1.44-7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants). CONCLUSION 24-hour in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out. KEY POINTS · Lower rates of DR cardiopulmonary resuscitation with 24h in-house NN coverage. · The type of 24h in-house coverage was not associated with mortality and/or major morbidity.. · High-volume centers more often have 24h in-house neonatal fellow coverage.
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Affiliation(s)
- Anthony Debay
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Prakesh Shah
- Departement of Pediatrics, Toronto University, Toronto, Ontario, Canada
| | - Abhay Lodha
- Departement of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sandesh Shivananda
- Departement of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Redpath
- Departement of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Seshia
- Departement of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jon Dorling
- Departement of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anie Lapointe
- Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Rody Canning
- Departement of Pediatrics, Moncton Hospital, Moncton, Alberta, Canada
| | - Lannae Strueby
- Departement of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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5
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Abdelmageed WA, Lapointe A, Brown R, Gorgos A, Luu TM, Beltempo M, Altit G, Dayan N. Association between maternal hypertension and infant neurodevelopment in extremely preterm infants. J Perinatol 2024; 44:539-547. [PMID: 38287138 DOI: 10.1038/s41372-024-01886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To examine the association between maternal hypertension during pregnancy and neurodevelopmental impairment (NDI) at 24 months post-menstrual age in extremely preterm infants. STUDY DESIGN Using data from two tertiary neonatal units (2011-2017) for infants born at 23 + 0 to 28 + 6 weeks, we investigated outcomes of NDI related to maternal hypertension and small-for-gestational-age (SGA) status. RESULTS Of 1019 pre-term infants, 647 had complete data and were included in the analysis. Ninety-six (15%) had maternal hypertension exposure; 25 (4%) were also SGA. Infants with maternal hypertension showed a higher odds of any NDI (aOR: 2.29, 95% CI = 1.36-3.87) and significant NDI (aOR: 2.01, 95% CI = 1.02-3.95). The combination of hypertension and SGA further elevated this risk (aOR for any NDI: 4.88, 95% CI = 1.80-13.22; significant NDI: 6.91, 95% CI = 2.50-19.12). CONCLUSION Maternal hypertension during pregnancy elevates the risk of NDI in extremely preterm infants, more so when combined with SGA.
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Affiliation(s)
- Wael A Abdelmageed
- Department of Medicine, Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - Richard Brown
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Andreea Gorgos
- Neonatal Follow-Up, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Thuy Mai Luu
- Neonatal Follow-Up, Department of Paediatrics, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Natalie Dayan
- Research Institute, McGill University Health Centre, Montreal, QC, Canada.
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Mukerji A, Read B, Yang J, Baczynski M, Ng E, Dunn M, Ethier G, Abou Mehrem A, Beltempo M, Drolet C, da Silva O, Louis D, Lemyre B, Afifi J, Singh B, Sherlock R, Stavel M, Masse E, Kanungo J, Wong J, Bodani J, Khurshid F, Lee KS, Augustine S, de Oliveira CB, Makary H, Newman A, Ojah C, Shah PS. CPAP Versus NIPPV Postextubation in Preterm Neonates: A Comparative-Effectiveness Study. Pediatrics 2024; 153:e2023064045. [PMID: 38511227 DOI: 10.1542/peds.2023-064045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Nasal intermittent positive pressure ventilation (NIPPV) has been shown to be superior to nasal continuous positive airway pressure (CPAP) postextubation in preterm neonates. However, studies have not permitted high CPAP pressures or rescue with other modes. We hypothesized that if CPAP pressures >8 cmH2O and rescue with other modes were permitted, CPAP would be noninferior to NIPPV. METHODS We conducted a pragmatic, comparative-effectiveness, noninferiority study utilizing network-based real-world data from 22 Canadian NICUs. Centers self-selected CPAP or NIPPV as their standard postextubation mode for preterm neonates <29 weeks' gestation. The primary outcome was failure of the initial mode ≤72 hours. Secondary outcomes included failure ≤7 days, and reintubation ≤72 hours and ≤7 days. Groups were compared using a noninferiority adjusted risk-difference (aRD) margin of 0.05, and margin of no difference. RESULTS A total of 843 infants extubated to CPAP and 974 extubated to NIPPV were included. CPAP was not noninferior (and inferior) to NIPPV for failure of the initial mode ≤72 hours (33.0% vs 26.3%; aRD 0.07 [0.03 to 0.12], Pnoninferiority(NI) = .86), and ≤7 days (40.7% vs 35.8%; aRD 0.09 [0.05 to 0.13], PNI = 0.97). However, CPAP was noninferior (and equivalent) to NIPPV for reintubation ≤72 hours (13.2% vs 16.1%; aRD 0.01 [-0.05 to 0.02], PNI < .01), and noninferior (and superior) for reintubation ≤7 days (16.4% vs 22.8%; aRD -0.04 [-0.07 to -0.001], PNI < .01). CONCLUSIONS CPAP was not noninferior to NIPPV for failure ≤72 hours postextubation; however, it was noninferior to NIPPV for reintubation ≤72 hours and ≤7 days. This suggests CPAP may be a reasonable initial postextubation mode if alternate rescue strategies are available.
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Affiliation(s)
- Amit Mukerji
- McMaster Children's Hospital, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Brooke Read
- London Health Sciences Centre, London, Ontario, Canada
| | - Junmin Yang
- Mount Sinai Hospital, Department of Pediatrics
| | | | - Eugene Ng
- Sunnybrook Health Sciences Centre, Department of Pediatrics
| | - Michael Dunn
- Sunnybrook Health Sciences Centre, Department of Pediatrics
| | - Guillaume Ethier
- CHU Sainte-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Ayman Abou Mehrem
- Foothills Medical Centre, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Marc Beltempo
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Christine Drolet
- CHU de Quebec, Department of Pediatrics, Laval University, Quebec, Quebec City, Canada
| | - Orlando da Silva
- London Health Sciences Centre, Department of Pediatrics, Western University, London, Ontario, Canada
| | - Deepak Louis
- Health Sciences Centre and St. Boniface Hospital, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brigitte Lemyre
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | - Edith Masse
- CIUSSSE-CHUS, Department of Pediatrics, University of Sherbrooke, Quebec, Canada
| | - Jaideep Kanungo
- Royal Victoria Hospital, University of Victoria, Victoria, British Columbia, Canada
| | - Jonathan Wong
- BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaya Bodani
- Regina General Hospital, Department of Pediatrics, University of Regina, Regina, Saskatchewan, Canada
| | - Faiza Khurshid
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kyong-Soon Lee
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Alana Newman
- Saint John Regional Hospital, Saint John, New Brunswick, Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
| | - Cecil Ojah
- Saint John Regional Hospital, Saint John, New Brunswick, Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
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Yeung T, Ahmed A, Wong J, Toye J, Abou Mehrem A, Mukerji A, Lapointe A, Ng E, Beltempo M, Pechlivanoglou P, Lee S, Shah PS. Variations in Site-Specific Costs for Infants Born Extremely Preterm in Canadian Neonatal Intensive Care Units. J Pediatr 2024; 266:113863. [PMID: 38096975 DOI: 10.1016/j.jpeds.2023.113863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28 weeks of gestation admitted to large tertiary neonatal intensive care units. METHODS We conducted a retrospective analysis of infants born at <28 weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. RESULTS Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94 992 ($60 283) and $174 438 ($130 501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. CONCLUSIONS There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.
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Affiliation(s)
- Telford Yeung
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital Metropolitan Campus, Windsor, Ontario, Canada
| | - Asma Ahmed
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Wong
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Toye
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Amit Mukerji
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Eugene Ng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marc Beltempo
- Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Petros Pechlivanoglou
- Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Shoo Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada; Mother-Infant Care Research Center, Toronto, Ontario, Canada.
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8
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Cervera SB, Saeed S, Luu TM, Gorgos A, Beltempo M, Claveau M, Basso O, Lapointe A, Tremblay S, Altit G. Evaluation of the association between patent ductus arteriosus approach and neurodevelopment in extremely preterm infants. J Perinatol 2024; 44:388-395. [PMID: 38278962 DOI: 10.1038/s41372-024-01877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Assess if unit-level PDA management correlates with neurodevelopmental impairment (NDI) at 18-24 months corrected postnatal age (CPA) in extremely preterm infants. STUDY DESIGN Retrospective analysis of infants born at <29 weeks (2014-2017) across two units having distinct PDA strategies. Site 1 utilized an echocardiography-based treatment strategy aiming for accelerated closure (control). Site 2 followed a conservative approach. PRIMARY ENDPOINT NDI, characterized by cerebral palsy, any Bayley-III composite score <85, sensorineural/mixed hearing loss, or at least unilateral visual impairment. RESULTS 377 infants were evaluated. PDA treatment rates remained unchanged in Site 1 but eventually reached 0% in Site 2. Comparable rates of any/significant NDI were seen across both sites (any NDI: 38% vs 36%; significant NDI: 13% vs 10% for Site 1 and 2, respectively). After adjustments, NDI rates remained similar. CONCLUSION PDA management strategies in extremely preterm newborns showed no significant impact on neurodevelopment outcomes at 18-24 months CPA.
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Affiliation(s)
- Soledad Belén Cervera
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thuy Mai Luu
- Neonatal Follow-Up, Department of Paediatrics, Université de Montréal, Montreal, QC, Canada
| | - Andrea Gorgos
- Neonatal Follow-Up, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Martine Claveau
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Anie Lapointe
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada
| | - Sophie Tremblay
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada
| | - Gabriel Altit
- Division of Neonatology, Department of Paediatrics, Sainte-Justine University Health Center, Montréal, QC, Canada.
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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10
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Peero EK, Banjar S, Khoudja R, Ton-Leclerc S, Beauchamp C, Benoit J, Beltempo M, Dahan MH, Gold P, Kadoch IJ, Jamal W, Laskin C, Mahutte N, Phillips S, Sylvestre C, Reinblatt S, Mazer BD, Buckett W, Genest G. Intravenous immunoglobulin for patients with unexplained recurrent implantation failure: a 6-year single center retrospective review of clinical outcomes. Sci Rep 2024; 14:3876. [PMID: 38365988 PMCID: PMC10873418 DOI: 10.1038/s41598-024-54423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024] Open
Abstract
The effectiveness of intravenous immunoglobulin (IVIg) for patients with unexplained recurrent implantation failure (uRIF) remains debated. We retrospectively analysed outcomes of uRIF patients treated with IVIg compared to a separate control uRIF cohort within our center (01/2014-12/2021). Primary outcomes included live birth, miscarriage, or transfer failure. We documented IVIg side effects and maternal/fetal outcomes. Logistic regression analysis was used to assess for association of IVIg exposure with outcomes and adjust for confounders. The study included 143 patients, with a 2:1 ratio of controls to patients receiving IVIg treatment. Patient characteristics were similar between groups. There was higher live birth rate (LBR) in patients receiving IVIg (32/49; 65.3%) compared to controls (32/94; 34%); p < 0.001). When stratifying patients into moderate and severe uRIF (respectively 3-4 and [Formula: see text] 5 previous good quality blastocyst transfer failures), only patients with severe uRIF benefited from IVIg (LBR (20/29 (69%) versus 5/25 (20%) for controls, p = 0.0004). In the logistic regression analysis, IVIg was associated with higher odds of live birth (OR 3.64; 95% CI 1.78-7.67; p = 0.0004). There were no serious adverse events with IVIg. IVIg can be considered in well selected patients with [Formula: see text] 5 previous unexplained, high quality blastocyst transfer failures. A randomized controlled trial is needed to confirm these findings.
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Affiliation(s)
- Einav Kadour Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Bnai-Zion Medical Center, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shorooq Banjar
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rabea Khoudja
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | | | - Coralie Beauchamp
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Joanne Benoit
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital - McGill University Health Centre, Montreal, QC, Canada
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
| | - Phil Gold
- Department of Allergy and Immunology, Montreal General Hospital, 1650 Cedar Ave. A6-123, Montreal, QC, H3G 1A4, Canada
| | - Isaac Jacques Kadoch
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Obstetrics and Gynaecology Department, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Wael Jamal
- Clinique OVO, 8000 boulevard Décarie, Montréal, QC, H4P 2S4, Canada
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Carl Laskin
- TRIO Fertility, 655 Bay St, Toronto, ON, M5G 2K4, Canada
- Deptartments of Medicine and Obstetrics & Gynecology University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, 5252 de Maisonneuve Blvd West, Suite 220, Montreal, QC, H4A 3S5, Canada
| | - Simon Phillips
- Clinique OVO, 8000 boulevard Décarie, Montréal, QC, H4P 2S4, Canada
- Faculty of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Camille Sylvestre
- Ovo Clinic, 8000 Boulevard Decarie, Montréal, QC, H4P 2S4, Canada
- Division of Reproductive Endocrinology and Infertility, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T1J4, Canada
| | - Shauna Reinblatt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- McGill University Health Care Reproductive Center, 888 Boul. De Maisonneuve E# 200, Montreal, QC, H2L 4S8, Canada
| | - Bruce D Mazer
- Department of Pediatrics, Division of Allergy Immunology and Clinical Dermatology, Montreal Children's Hospital, McGill University, Montréal, QC, Canada
- Program in Translational Research in Respiratory Diseases, Research Institute of the McGill, University Health Centre, Montréal, QC, Canada
| | - William Buckett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, QC, Canada
- McGill University Health Care Reproductive Center, 888 Boul. De Maisonneuve E# 200, Montreal, QC, H2L 4S8, Canada
| | - Genevieve Genest
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.
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11
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Jabbour E, Patel S, Lacroix G, Pechlivanoglou P, Shah PS, Beltempo M. Validation of a Costing Algorithm and Cost Drivers for Neonates Admitted to the Neonatal Intensive Care Unit. Am J Perinatol 2024. [PMID: 38262468 DOI: 10.1055/a-2251-6238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Neonatal intensive care units (NICUs) account for over 35% of pediatric in-hospital costs. A better understanding of NICU expenditures may help identify areas of improvements. This study aimed to validate the Canadian Neonatal Network (CNN) costing algorithm for seven case-mix groups with actual costs incurred in a tertiary NICU and explore drivers of cost. STUDY DESIGN A retrospective cohort study of infants admitted within 24 hours of birth to a Level-3 NICU from 2016 to 2019. Patient data and predicted costs were obtained from the CNN database and were compared to actual obtained from the hospital accounting system (Coût par Parcours de Soins et de Services). Cost estimates (adjusted to 2017 Canadian Dollars) were compared using Spearman correlation coefficient (rho). RESULTS Among 1,795 infants included, 169 (9%) had major congenital anomalies, 164 (9%) with <29 weeks' gestational age (GA), 189 (11%) with 29 to 32 weeks' GA, and 452 (25%) with 33 to 36 weeks' GA. The rest were term infants: 86 (5%) with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia, 194 (11%) requiring respiratory support, and 541 (30%) admitted for other reasons. Median total NICU costs varied from $6,267 (term infants admitted for other reasons) to $211,103 (infants born with <29 weeks' GA). Median daily costs ranged from $1,613 to $2,238. Predicted costs correlated with actual costs across all case-mix groups (rho range 0.78-0.98, p < 0.01) with physician and nursing representing the largest proportion of total costs (65-82%). CONCLUSION The CNN algorithm accurately predicts NICU total costs for seven case-mix groups. Personnel costs account for three-fourths of in-hospital total costs of all infants in the NICU. KEY POINTS · Very preterm infants born below 33 weeks of gestation account for most of NICU resource use.. · Human resources providing direct patient care represented the largest portion of costs.. · The algorithm strongly predicted total costs for all case-mix groups..
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Affiliation(s)
- Elias Jabbour
- Division of Neonatology, Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Canada
| | - Sharina Patel
- Division of Neonatology, Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Canada
- Division of Neonatology, Department of Pediatrics, McGill University Health Center, Montreal, Canada
| | - Guy Lacroix
- Department of Economics, University of Laval, Montreal, Canada
| | | | - Prakesh S Shah
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Canada
- Division of Neonatology, Department of Pediatrics, McGill University Health Center, Montreal, Canada
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12
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Garfinkle J, Khairy M, Simard MN, Wong J, Shah PS, Luu TM, Beltempo M. Corrected Age at Bayley Assessment and Developmental Delay in Extreme Preterms. Pediatrics 2024; 153:e2023063654. [PMID: 38186292 DOI: 10.1542/peds.2023-063654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Research on outcomes of prematurity frequently examines neurodevelopment in the toddler years as an end point, but the age range at examination varies. We aimed to evaluate whether the corrected age (CA) at Bayley-III assessment is associated with rates of developmental delay in extremely preterm children. METHODS This retrospective cohort study included children born at <29 weeks' gestation who were admitted in the Canadian Neonatal Network between 2009 and 2017. The primary outcomes were significant developmental delay (Bayley-III score <70 in any domain) and developmental delay (Bayley-III score <85 in any domain). To assess the association between CA at Bayley-III assessment and developmental delay, we compared outcomes between 2 groups of children: those assessed at 18 to 20 months' CA and 21-24 months. RESULTS Overall, 3944 infants were assessed at 18-20 months' CA and 881 at 21-24 months. Compared with infants assessed at 18-20 months, those assessed at 21-24 months had higher odds of significant development delay (20.0% vs 12.5%; adjusted odds ratio, 1.75; 95% confidence interval [CI], 1.41-2.13) and development delays (48.9% vs 41.7%, adjusted odds ratio 1.33; 95% CI, 1.11-1.52). Bayley-III composite scores were on average 3 to 4 points lower in infants evaluated at 21-24 months' CA (for instance, adjusted mean difference and 95% CI for language: 3.49 [2.33-4.66]). Conversely, rates of cerebral palsy were comparable (4.6% vs 4.7%) between the groups. CONCLUSIONS Bayley-III assessments performed at 21-24 months' CA were more likely to diagnose a significant developmental delay compared with 18- to 20-month assessments in extremely preterm children.
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Affiliation(s)
- Jarred Garfinkle
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - May Khairy
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | | | - Jonathan Wong
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Beltempo
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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13
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Moore SS, De Carvalho Nunes G, Dancea A, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. Early cardiac function and death, severe bronchopulmonary dysplasia and pulmonary hypertension in extremely preterm infants. Pediatr Res 2024; 95:293-301. [PMID: 37726544 DOI: 10.1038/s41390-023-02817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Association between early cardiac function and neonatal outcomes are scarcely reported. The aim of the current study was to describe this association with death, severe bronchopulmonary dysplasia (BPD) and BPD-related pulmonary hypertension (PH). METHODS Retrospective cohort study of infants <29 weeks born between 2015 and 2019. Infants with clinically acquired echocardiography at ≤21 days after birth were included and data were extracted by an expert masked to outcomes. RESULTS A total of 176 infants were included. Echocardiogram was performed at a median of 9 days (IQR 5-13.5). Of these, 31 (18%) had death/severe BPD and 59 (33.5%) had death/BPD-related PH. Infants with death/severe BPD were of lower birth weight (745 [227] vs 852 [211] grams, p = 0.01) and more exposed to invasive ventilation, late-onset sepsis, inotropes and/or postnatal steroids. Early echocardiograms demonstrated decreased right ventricular [Tricuspid Annular Plane Systolic Excursion: 5.2 (1.4) vs 6.2 (1.5) cm, p = 0.03] and left ventricular function [Ejection fraction 53 (14) vs 58 (10) %, p = 0.03]. Infants with death/BPD-related PH had an increased Eccentricity index (1.35 [0.20] vs 1.26 [0.19], p = 0.02), and flat/bowing septum (19/54 [35%] vs 20/109 [18%], p = 0.021). CONCLUSIONS In extremely premature infants, altered ventricular function and increased pulmonary pressure indices within the first 21 days after birth, were associated with the combined outcome of death/severe BPD and death/BPD-related PH. IMPACT Decreased cardiac function on echocardiography performed during first three weeks of life is associated with severe bronchopulmonary dysplasia in extremely premature infants. In extreme preterm infants, echocardiographic signs of pulmonary hypertension in early life are associated with later BPD-related pulmonary hypertension close to 36 weeks post-menstrual age. Early cardiac markers should be further studied as potential intervention targets in this population. Our study is adding comprehensive analysis of echocardiographic data in infants born below 29 weeks gestational age.
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Affiliation(s)
- Shiran S Moore
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
- Neonatology-Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabriela De Carvalho Nunes
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Adrian Dancea
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | | | - Jessica Simoneau
- Pediatric Cardiology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Guilherme Sant'Anna
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada
| | - Gabriel Altit
- Neonatology-McGill University Health Centre-Montreal Children's Hospital; Department of Pediatrics-McGill University, Montreal, QC, Canada.
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14
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Groulx-Boivin E, Paquette M, Khairy M, Beltempo M, Dudley R, Ferrand A, Guillot M, Bizgu V, Garfinkle J. Spontaneous resolution of post-hemorrhagic ventricular dilatation in preterm newborns and neurodevelopment. Pediatr Res 2023; 94:1428-1435. [PMID: 37179437 DOI: 10.1038/s41390-023-02647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND We investigated the temporal evolution of post-hemorrhagic ventricular dilatation (PHVD) and compared neurodevelopmental impairments (NDI) in newborns with (Group 1) spontaneous resolution of PHVD, (Group 2) persistent PHVD without neurosurgical intervention, and (Group 3) progressive PHVD receiving neurosurgical intervention. METHODS A multicenter retrospective cohort study of newborns born at ≤34 weeks with PHVD (ventricular index [VI] >97th centile for gestational age and anterior horn width [AHW] >6 mm) from 2012 to 2020. Severe NDI was defined as global developmental delay or cerebral palsy GMFCS III-V at 18 months. RESULTS Of 88 survivors with PHVD, 39% had a spontaneous resolution, 17% had persistent PHVD without intervention, and 44% had progressive PHVD receiving intervention. The median time between PHVD diagnosis and spontaneous resolution was 14.0 days (IQR 6.8-32.3) and between PHVD diagnosis and first neurosurgical intervention was 12.0 days (IQR 7.0-22.0). Group 1 had smaller median maximal VI (1.8, 3.4, 11.1 mm above p97; p < 0.001) and AHW (7.2, 10.8, 20.3 mm; p < 0.001) than Groups 2 and 3. Neurodevelopmental outcome data were available for 82% of survivors. Group 1 had reduced severe NDI compared to Group 3 (15% vs 66%; p < 0.001). CONCLUSION Newborns with PHVD without spontaneous resolution are at higher risk for impairments despite neurosurgical interventions, which may be due to larger ventricular dilatation. IMPACT The natural evolution of post-hemorrhagic ventricular dilatation (PHVD) and developmental implications of spontaneous resolution are not well established. In this study, approximately one in three newborns with PHVD experienced spontaneous resolution and this subset of newborns had reduced rates of neurodevelopmental impairments. More prominent ventricular dilatation was associated with reduced rates of spontaneous resolution and increased rates of severe neurodevelopmental impairment among newborns with PHVD. Understanding clinically relevant time points in the evolution of PHVD and predictors of spontaneous resolution may help inform the discussion around the optimal timing for intervention and allow for more precise prognostication in this population.
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Affiliation(s)
- Emilie Groulx-Boivin
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Mariane Paquette
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - May Khairy
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Roy Dudley
- Department of Pediatric Surgery, Division of Neurosurgery, McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | - Amaryllis Ferrand
- Division of Neonatology, Department of Pediatrics, McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Mireille Guillot
- Department of Pediatrics, Université Laval, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, Canada
| | - Victoria Bizgu
- Division of Neonatology, Department of Pediatrics, McGill University, Jewish General Hospital, Montréal, QC, Canada
| | - Jarred Garfinkle
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada.
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15
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Ninan K, Gojic A, Wang Y, Asztalos EV, Beltempo M, Murphy KE, McDonald SD. The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants. BMJ 2023; 382:e076035. [PMID: 37532269 PMCID: PMC10394681 DOI: 10.1136/bmj-2023-076035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To systematically review the proportions of infants with early exposure to antenatal corticosteroids but born at term or late preterm, and short term and long term outcomes. DESIGN Systematic review and meta-analyses. DATA SOURCES Eight databases searched from 1 January 2000 to 1 February 2023, reflecting recent perinatal care, and references of screened articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials and population based cohort studies with data on infants with early exposure to antenatal corticosteroids (<34 weeks) but born at term (≥37 weeks), late preterm (34-36 weeks), or term/late preterm combined. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles, abstracts, and full text articles and assessed risk of bias (Cochrane risk of bias tool for randomised controlled trials and Newcastle-Ottawa scale for population based studies). Reviewers extracted data on populations, exposure to antenatal corticosteroids, and outcomes. The authors analysed randomised and cohort data separately, using random effects meta-analyses. MAIN OUTCOME MEASURES The primary outcome was the proportion of infants with early exposure to antenatal corticosteroids but born at term. Secondary outcomes included the proportions of infants born late preterm or term/late preterm combined after early exposure to antenatal corticosteroids and short term and long term outcomes versus non-exposure for the three gestational time points (term, late preterm, term/late preterm combined). RESULTS Of 14 799 records, the reviewers screened 8815 non-duplicate titles and abstracts and assessed 713 full text articles. Seven randomised controlled trials and 10 population based cohort studies (1.6 million infants total) were included. In randomised controlled trials and population based data, ∼40% of infants with early exposure to antenatal corticosteroids were born at term (low or very low certainty). Among children born at term, early exposure to antenatal corticosteroids versus no exposure was associated with increased risks of admission to neonatal intensive care (adjusted odds ratio 1.49, 95% confidence interval 1.19 to 1.86, one study, 5330 infants, very low certainty; unadjusted relative risk 1.69, 95% confidence interval 1.51 to 1.89, three studies, 1 176 022 infants, I2=58%, τ2=0.01, low certainty), intubation (unadjusted relative risk 2.59, 1.39 to 4.81, absolute effect 7 more per 1000, 95% confidence interval from 2 more to 16 more, one study, 8076 infants, very low certainty, one study, 8076 infants, very low certainty), reduced head circumference (adjusted mean difference -0.21, 95% confidence interval -0.29 to -0.13, one study, 183 325 infants, low certainty), and any long term neurodevelopmental or behavioural disorder in population based studies (eg, any neurodevelopmental or behavioural disorder in children born at term, adjusted hazard ratio 1.47, 95% confidence interval 1.36 to 1.60, one study, 641 487 children, low certainty). CONCLUSIONS About 40% of infants exposed to early antenatal corticosteroids were born at term, with associated adverse short term and long term outcomes (low or very low certainty), highlighting the need for caution when considering antenatal corticosteroids. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022360079.
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Affiliation(s)
- Kiran Ninan
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Anja Gojic
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Yanchen Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Elizabeth V Asztalos
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Kellie E Murphy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, L8S 4K1, Canada
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Banjar S, Kadour E, Khoudja R, Ton-Leclerc S, Beauchamp C, Beltempo M, Dahan MH, Gold P, Jacques Kadoch I, Jamal W, Laskin C, Mahutte N, Reinblatt SL, Sylvestre C, Buckett W, Genest G. Intravenous immunoglobulin use in patients with unexplained recurrent pregnancy loss. Am J Reprod Immunol 2023; 90:e13737. [PMID: 37491929 DOI: 10.1111/aji.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023] Open
Abstract
PROBLEM Recurrent pregnancy loss (RPL) affects up to 4% of couples attempting to conceive. RPL is unexplained in over 50% of cases and no effective treatments exist. Due to the immune system's pivotal role during implantation and pregnancy, immune-mediated RPL may be suspected and immunomodulatory treatments like intravenous immunoglobulin (IVIg) have been administered but remain controversial. The goal of our study was to evaluate our center's 6 year-outcomes and to develop a framework for IVIg use in RPL. METHOD OF THE STUDY Retrospective, single-center cohort study. All patients having received IVIg for unexplained RPL at the McGill Reproductive Immunology Clinic (MRIC) from January 2014 to December 2020 were included if maternal age was <42 years, body mass index (BMI) < 35 kg/m2 , non-smoker and having had ≥3 consecutive RPL despite previous treatment with aspirin and progesterone. IVIg 0.6-0.8 g/kg was given prior to conception and monthly during pregnancy until 16-20 weeks' gestation. We compared IVIg treated patient's outcomes to a separate "natural history cohort". This cohort was composed of patients consulting at the McGill recurrent pregnancy loss clinic and the MRIC over a 2-year period (January 2020 to December 2021) with similar inclusion criteria as the treatment cohort but did not receive IVIg or other immunomodulatory treatments. The association of IVIg with outcomes (compared to no IVIg) was evaluated among the groups of patients with primary RPL and secondary RPL. The primary outcome was live birth rate (LBR), secondary outcomes included IVIg safety, obstetrical, and neonatal complications. RESULTS Among 169 patients with unexplained RPL that were included in the study, 111 had primary RPL (38 exposed to IVIg and 83 controls) and 58 had secondary RPL (nine exposed to IVIG and 49 controls). Among patients with primary RPL (n = 111), the LBR was 64.3% (18/28) among patient exposed to IVIg compared to 43.4% (36/83) in controls (p = 0.079); regression analysis adjusting for BMI and number of previous miscarriages showed benefit favoring the use of IVIg (OR = 3.27, CI 95% (1.15-10.2), p = 0.03) when evaluating for live birth. In the subgroup of patients with ≥5 previous RPL and primary RPL (n = 31), IVIg was associated with higher LBR compared to control (10/15 (66.7%) vs. 3/16 (18.8%); p = 0.0113) but not the in the sub-group of patients with <5 miscarriages and primary RPL (8/13 (61.5%) vs. 33/67 (49.3%); p = 0.548). IVIG treatment did not improve LBR in patients with secondary RPL in our study (3/9 (33.3%) vs. 23/49 (47%); p = 0.495). There were no serious adverse events in the IVIg treatment group, obstetrical/neonatal complications were similar between groups. CONCLUSION IVIg may be an effective treatment for patients with RPL if appropriately used in specific groups of patients. IVIg is a blood product and subject to shortages especially with unrestricted off-label use. We propose considering IVIg in well-selected patients with high order RPL who have failed standard medical therapy. Further mechanistic studies are needed to understand immune-mediated RPL and IVIg's mode of action. This will enable further refinement of treatment criteria and the development of standardized protocol for its use in RPL.
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Affiliation(s)
- Shorooq Banjar
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Einav Kadour
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Bnai-Zion Medical Center, Rishon-Le-Zion, Israel
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Rabea Khoudja
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | | | - Coralie Beauchamp
- Ovo Clinic, Montréal, Québec, Canada
- Obstetrics and Gynaecology Department, University of Montreal, Montreal, Quebec
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital - McGill University Health Centre, Montreal, Québec, Canada
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Phil Gold
- Department of Allergy and Immunology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Isaac Jacques Kadoch
- Ovo Clinic, Montréal, Québec, Canada
- Obstetrics and Gynaecology Department, University of Montreal, Montreal, Quebec
| | - Wael Jamal
- Clinique OVO, Montréal, Québec, Canada
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
| | - Carl Laskin
- TRIO Fertility, Toronto, Ontario, Canada
- Deptartments of Medicine and Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - Neal Mahutte
- The Montreal Fertility Centre, Montreal, Quebec, Canada
| | - Shauna Leigh Reinblatt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Camille Sylvestre
- Ovo Clinic, Montréal, Québec, Canada
- Division of Reproductive Endocrinology and Infertility, University of Montreal, Montreal, Quebec, Canada
| | - William Buckett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
- McGill University Health Care Reproductive Center, Montreal, Quebec, Canada
| | - Genevieve Genest
- Division of Clinical Immunology and Allergy, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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17
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Marc I, Lavoie PM, McPhee AJ, Collins CT, Simonyan D, Pronovost E, Guillot M, Gould JF, Mohamed I, Beltempo M, Boutin A, Fortier I, Sullivan TR, Moore L, Makrides M. Enteral supplementation with high-dose docosahexaenoic acid on the risk of bronchopulmonary dysplasia in very preterm infants: a collaborative study protocol for an individual participant data meta-analysis. BMJ Open 2023; 13:e076223. [PMID: 37518076 PMCID: PMC10387660 DOI: 10.1136/bmjopen-2023-076223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Severe bronchopulmonary dysplasia (BPD) is a well-known factor consistently associated with impaired cognitive outcomes. Regarding reported benefits on long-term neurodevelopmental outcomes, the potential adverse effects of high-dose docosahexaenoic acid (DHA) supplementation on this short-term neonatal morbidity need further investigations in infants born very preterm. This study will determine whether high-dose DHA enteral supplementation during the neonatal period is associated with the risk of severe BPD at 36 weeks' postmenstrual age (PMA) compared with control, in contemporary cohorts of preterm infants born at less than 29 weeks of gestation. METHODS AND ANALYSIS As part of an Australian-Canadian collaboration, we will conduct an individual participant data (IPD) meta-analysis of randomised controlled trials targeting infants born at less than 29 weeks of gestation and evaluating the effect of high-dose DHA enteral supplementation in the neonatal period compared with a control. Primary outcome will be severe grades of BPD (yes/no) at 36 weeks' PMA harmonised according to a recent definition that predicts early childhood morbidities. Other outcomes will be survival without severe BPD, death, BPD severity grades, serious brain injury, severe retinopathy of prematurity, patent ductus arteriosus and necrotising enterocolitis requiring surgery, sepsis, combined neonatal morbidities and growth. Severe BPD will be compared between groups using a multivariate generalised estimating equations log-binomial regression model. Subgroup analyses are planned for gestational age, sex, small-for-gestational age, presence of maternal chorioamnionitis and mode of delivery. ETHICS AND DISSEMINATION The conduct of each trial was approved by institutional research ethics boards and written informed consent was obtained from participating parents. A collaboration and data sharing agreement will be signed between participating authors and institutions. This IPD meta-analysis will document the role of DHA in nutritional management of BPD. Findings will be disseminated through conferences, media interviews and publications to peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42023431063. TRIAL REGISTRATION NUMBER NCT05915806.
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Affiliation(s)
- Isabelle Marc
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew J McPhee
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Simonyan
- Clinical and Evaluative Research Platform, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Mireille Guillot
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Jacqueline F Gould
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine and School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Amélie Boutin
- Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Québec, Canada
| | - Isabel Fortier
- Maelstrom Research, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Thomas R Sullivan
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, Quebec City, Québec, Canada
| | - Maria Makrides
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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18
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Morin J, Delaney J, Nunes GDC, Simoneau J, Beltempo M, Goudie C, Malhamé I, Altit G. Exposure to maternal acetylsalicylic acid and the risk of bleeding events in extreme premature neonates. J Perinatol 2023; 43:946-948. [PMID: 36914800 DOI: 10.1038/s41372-023-01644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/23/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Justine Morin
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Joanne Delaney
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gabriela De Carvalho Nunes
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Jessica Simoneau
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Catherine Goudie
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Isabelle Malhamé
- Department of Medicine, General Internal Medicine, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Gabriel Altit
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada.
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19
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Raina J, Elgbeili G, Montreuil T, Nguyen TV, Beltempo M, Kusuma D, Tulandi T, Dayan N, Bahroen FY, Caccese C, Badeghiesh A, Suarthana E. Erratum to "The effect of maternal hypertension and maternal mental illness on adverse neonatal outcomes: A mediation and moderation analysis in a U.S. cohort of 9 million pregnancies" [J. Affect. Disord. 326C (2023) 11-17]. J Affect Disord 2023; 331:462. [PMID: 37002112 DOI: 10.1016/j.jad.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Jason Raina
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | | | - Tina Montreuil
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Tuong-Vi Nguyen
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Marc Beltempo
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Dian Kusuma
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, UK
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Natalie Dayan
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada; Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Femmy Yunia Bahroen
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | | | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada.
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20
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Moore SS, De Carvalho Nunes G, Villegas Martinez D, Dancea A, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. Association of gestational age at birth with left cardiac dimensions at near term corrected age among extremely preterm infants. J Am Soc Echocardiogr 2023:S0894-7317(23)00193-1. [PMID: 37044171 DOI: 10.1016/j.echo.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Remodelling and altered ventricular geometry have been described in premature-born adults. Although they seem to have an adverse cardiac phenotype, the impact of various degrees of prematurity on cardiac development has been scarcely reported. In this study, we evaluated the impact of gestational age (GA) at birth on cardiac dimensions and function at near term age among extremely preterm infants. METHODS Retrospective single center cohort study of infants born <29 weeks GA between 2015-2019. Infants with available clinically acquired echocardiography between 34-43 weeks were included. Two groups were investigated: born <26 weeks or ≥26 weeks. All measurements were done by an expert masked to clinical data, using the raw images. The primary outcome was measurements of cardiac dimensions and function based on GA group. Secondary outcomes were the association between cardiac dimensions and post-natal steroid exposure, and with increments of GA at birth. RESULTS A total of 205 infants were included (<26 weeks n=102, ≥26 weeks n=103). At time of echocardiography, weight (2.4 ±0.5 vs 2.5 ±0.5 kg, p=0.86) and age (37.2 ±1.6 vs 37.1 ±1.9 weeks, p=0.74) were similar between groups. There was no difference in metrics of right-sided dimensions and function. However, left-sided dimensions were decreased in infants born <26 weeks, including systolic left ventricle (LV) diameter (1.06 ±0.20 cm vs 1.12 ±0.18 cm, p=0.02), diastolic LV length (2.85 ±0.37 vs 3.02 ±0.57 cm, p=0.02), and estimated LV end diastolic volume (EDV) (5.36 ±1.69 vs 6.01 ±1.79 mL, p=0.02). CONCLUSIONS In our cohort of very immature infants, birth at the extreme of prematurity was associated with smaller left cardiac dimensions around 36 weeks of corrected age. Future longitudinal prospective studies should evaluate further the impact of prematurity on LV development and performance, and their long-term clinical impact.
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Affiliation(s)
- Shiran Sara Moore
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada; Neonatology - Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gabriela De Carvalho Nunes
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | - Daniela Villegas Martinez
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | - Adrian Dancea
- Pediatric Cardiology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | | | - Jessica Simoneau
- Pediatric Cardiology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | - Marc Beltempo
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | - Guilherme Sant'Anna
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada
| | - Gabriel Altit
- Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University, Montreal, Quebec, Canada.
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21
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Raina J, Elgbeili G, Montreuil T, Nguyen TV, Beltempo M, Kusuma D, Tulandi T, Dayan N, Bahroen FY, Caccese C, Badageish A, Suarthana E. The effect of maternal hypertension and maternal mental illness on adverse neonatal outcomes: A mediation and moderation analysis in a U.S. cohort of 9 million pregnancies. J Affect Disord 2023; 326:11-17. [PMID: 36657493 DOI: 10.1016/j.jad.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND While hypertensive disorders of pregnancy (HDP) coexist with maternal anxiety and depression, it is unclear how these conditions affect neonatal outcomes. We evaluated the prevalence as well as associations and potential mechanisms between HDP, maternal anxiety and depression, preterm birth (PTB), and small for gestational age (SGA). METHODS We conducted a retrospective population-based study using the Healthcare Cost and Utilization Project (HCUP) database from 2004 to 2014. Preterm birth (<37 weeks), SGA (<10th percentile for gestational age and sex), HDP, and mental disorders (anxiety and depression) were extracted using the International Classification of Diseases, Ninth Revision (ICD-9). Mediation and moderation models were constructed separately to evaluate potential mechanisms between maternal anxiety and depression, HDP, and adverse neonatal outcomes. Multivariate logistic regressions were used to determine their associations. RESULTS Of 9,097,355 pregnant women, the prevalence of HDP was 6.9 %, anxiety 0.91 %, depression 0.36 %, preterm birth 7.2 %, and SGA 2.1 %. Anxiety increased the probability of having HDP (OR = 1.242, 95 % CI 1.235-1.250), and HDP mediated the association between anxiety and preterm birth (mediation effect = 0.048, p-value<0.001). Depression significantly moderated the effect of HDP on preterm birth (moderation effect = -0.126, p-value = 0.027). HDP also mediated the association between anxiety and SGA (mediation effect = 0.042, p-value<0.001), but depression did not moderate the association between HDP and SGA (p-value = 0.29). CONCLUSION Our study suggests that women with anxiety are more likely to have HDP, and HDP mediates the associations between anxiety and adverse neonatal outcomes. Depression moderates associations between HDP and preterm birth but not between HDP and SGA.
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Affiliation(s)
- Jason Raina
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | | | - Tina Montreuil
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Tuong-Vi Nguyen
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada; Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Marc Beltempo
- McGill University Health Center, Montréal, Québec, Canada
| | - Dian Kusuma
- Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Natalie Dayan
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada; Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, UK
| | - Femmy Yunia Bahroen
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | | | - Ahmad Badageish
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada.
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22
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Beltempo M. "ECI Biocommentary: Marc Beltempo". Pediatr Res 2023; 93:1450. [PMID: 36859441 DOI: 10.1038/s41390-023-02544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Centre, Montreal, QC, Canada.
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23
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de Carvalho Nunes G, Wutthigate P, Simoneau J, Dancea A, Beltempo M, Renaud C, Altit G. The biventricular contribution to chronic pulmonary hypertension of the extremely premature infant. J Perinatol 2023; 43:174-180. [PMID: 36008520 DOI: 10.1038/s41372-022-01497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Evaluate factors associated with significant pulmonary hypertension [PH] (≥2/3 systemic) and its impact on ventricular function at 36 weeks postmenstrual age (PMA). STUDY DESIGN Retrospective cohort of infants born at <29 weeks who survived to their echocardiography screening for PH at 36 weeks PMA. Masked experts extracted conventional and speckle-tracking echocardiography [STE] data. RESULTS Of 387 infants, 222 were included and 24 (11%) categorized as significant PH. Significant PH was associated with a decrease in tricuspid annular plane systolic excursion (0.79 vs 0.87 cm, p = 0.03), right peak longitudinal strain [pLS] by STE (-19.6 vs -23.1%, p = 0.003) and left pLS (-25.0 vs -22.7%, p = 0.02). The association between biventricular altered function by STE and significant PH persisted after adjustment for potential confounders - LV-pLS (p = 0.007) and RV-pLS (p = 0.01). CONCLUSION Our findings are suggestive that premature newborns with significant PH at 36 weeks PMA have a biventricular cardiac involvement to their pathophysiology.
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Affiliation(s)
- Gabriela de Carvalho Nunes
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Punnanee Wutthigate
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Neonatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jessica Simoneau
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Adrian Dancea
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Pediatric Cardiology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Marc Beltempo
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Claudia Renaud
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.,Division of Pediatric Cardiology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada
| | - Gabriel Altit
- McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada. .,Division of Neonatology, McGill University Health Centre-Montreal Children's Hospital, Quebec, QC, Canada.
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24
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Delaney J, Nunes GDC, Simoneau J, Beltempo M, Malhamé I, Goudie C, Altit G. Thrombocytopenia and neonatal outcomes among extremely premature infants exposed to maternal hypertension. Pediatr Blood Cancer 2023; 70:e30131. [PMID: 36478101 DOI: 10.1002/pbc.30131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with neonatal hematological disturbances, such as thrombocytopenia. The association of HDP to platelet counts in the context of extreme prematurity, to trends of platelet counts during neonatal hospitalization, and to frequency of platelet transfusions remain to be explored. PROCEDURE Retrospective study of infants born at less than 29 weeks born between 2015 and 2019. Platelet counts were collected on initial complete blood count, at 2 weeks, 32 weeks post-menstrual age (PMA), 36 weeks PMA, and closest to discharge. We examined the association between HDP and platelet counts at each time point, frequency of platelet transfusions and intraventricular hemorrhage (IVH) grade 3 or more. RESULTS Total 296 infants were included, 43 exposed to HDP. Infants exposed had lower platelet counts at each time point, as well as a higher prevalence of platelet less than 150 × 109 /L on one of the time points (32% vs. 65%, p < .001). Infants exposed to maternal hypertension were more frequently exposed to platelet transfusions (63% vs. 18%, p < .001). Mixed effect model demonstrated an association between HDP and a lower trend in platelet counts at each time point (β = -94 × 103 /μl, p < .001). Although initial platelet count was associated with severe IVH, it was not associated to exposure to HDP. CONCLUSION Premature infants exposed to HDP have a higher prevalence of thrombocytopenia, increased frequency of platelet transfusion, and an altered trend in platelet counts during neonatal hospitalization.
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Affiliation(s)
- Joanne Delaney
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gabriela De Carvalho Nunes
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jessica Simoneau
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Marc Beltempo
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Isabelle Malhamé
- Department of Medicine, General Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Goudie
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gabriel Altit
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Beltempo M, Bresson G, Lacroix G. Using machine learning to predict nosocomial infections and medical accidents in a NICU. Health Technol 2023. [DOI: 10.1007/s12553-022-00723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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26
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Beltempo M, Patel S, Platt RW, Julien AS, Blais R, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B. Association of nurse staffing and unit occupancy with mortality and morbidity among very preterm infants: a multicentre study. Arch Dis Child Fetal Neonatal Ed 2023:archdischild-2022-324414. [PMID: 36609411 DOI: 10.1136/archdischild-2022-324414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE In a healthcare system with finite resources, hospital organisational factors may contribute to patient outcomes. We aimed to assess the association of nurse staffing and neonatal intensive care unit (NICU) occupancy with outcomes of preterm infants born <33 weeks' gestation. DESIGN Retrospective cohort study. SETTING Four level III NICUs. PATIENTS Infants born 23-32 weeks' gestation 2015-2018. MAIN OUTCOME MEASURES Nursing provision ratios (nursing hours worked/recommended nursing hours based on patient acuity categories) and unit occupancy rates were averaged for the first shift, 24 hours and 7 days of admission of each infant. Primary outcome was mortality/morbidity (bronchopulmonary dysplasia, severe neurological injury, retinopathy of prematurity, necrotising enterocolitis and nosocomial infection). ORs for association of exposure with outcomes were estimated using generalised linear mixed models adjusted for confounders. RESULTS Among 1870 included infants, 823 (44%) had mortality/morbidity. Median nursing provision ratio was 1.03 (IQR 0.89-1.22) and median unit occupancy was 89% (IQR 82-94). In the first 24 hours of admission, higher nursing provision ratio was associated with lower odds of mortality/morbidity (OR 0.93, 95% CI 0.89 to 0.98), and higher unit occupancy was associated with higher odds of mortality/morbidity (OR 1.19, 95% CI 1.04 to 1.36). In causal mediation analysis, nursing provision ratios mediated 47% of the association between occupancy and outcomes. CONCLUSIONS NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.
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Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sharina Patel
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Robert W Platt
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Anne-Sophie Julien
- Département de mathématiques et de statistique, Université Laval, Quebec City, Quebec, Canada
| | - Régis Blais
- Département de gestion, d'évaluation et de politique de santé, Université de Montréal, Montreal, Quebec, Canada
| | - Valerie Bertelle
- Departement of Pediatrics, Université de Sherbooke, Sherbrooke, Quebec, Canada
| | - Anie Lapointe
- Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Quebec City, Quebec, Canada
| | - Sophie Gravel
- Division of Neonatalogy, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Michèle Cabot
- Division of Neonatalogy, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Bruno Piedboeuf
- Departement of Pediatrics, Université Laval, Quebec City, Quebec, Canada
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27
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Shalish W, Keszler M, Kovacs L, Chawla S, Latremouille S, Beltempo M, Kearney RE, Sant'Anna GM. Age at First Extubation Attempt and Death or Respiratory Morbidities in Extremely Preterm Infants. J Pediatr 2023; 252:124-130.e3. [PMID: 36027982 DOI: 10.1016/j.jpeds.2022.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the timing of first extubation in extremely preterm infants and explore the relationship between age at first extubation, extubation outcome, and death or respiratory morbidities. STUDY DESIGN In this subanalysis of a multicenter observational study, infants with birth weights of 1250 g or less and intubated within 24 hours of birth were included. After describing the timing of first extubation, age at extubation was divided into early (within 7 days from birth) vs late (days of life 8-35), and extubation outcome was divided into success vs failure (reintubation within 7 days after extubation), to create 4 extubation groups: early success, early failure, late success, and late failure. Logistic regression analyses were performed to evaluate associations between the 4 groups and death or bronchopulmonary dysplasia, bronchopulmonary dysplasia among survivors, and durations of respiratory support and oxygen therapy. RESULTS Of the 250 infants included, 129 (52%) were extubated within 7 days, 93 (37%) between 8 and 35 days, and 28 (11%) beyond 35 days of life. There were 93, 36, 59, and 34 infants with early success, early failure, late success, and late failure, respectively. Although early success was associated with the lowest rates of respiratory morbidities, early failure was not associated with significantly different respiratory outcomes compared with late success or late failure in unadjusted and adjusted analyses. CONCLUSIONS In a contemporary cohort of extremely preterm infants, early extubation occurred in 52% of infants, and only early and successful extubation was associated with decreased respiratory morbidities. Predictors capable of promptly identifying infants with a high likelihood of early extubation success or failure are needed.
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Affiliation(s)
- Wissam Shalish
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Martin Keszler
- Division of Neonatology, Women and Infants Hospital of Rhode Island, Brown University, Providence, RI
| | - Lajos Kovacs
- Department of Neonatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sanjay Chawla
- Division of Neonatal-Perinatal Medicine, Hutzel Women's Hospital, Children's Hospital of Michigan, Central Michigan University, Wayne State University, Detroit, MI
| | - Samantha Latremouille
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Marc Beltempo
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Robert E Kearney
- Division of Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Guilherme M Sant'Anna
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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Patel S, Martel-Bucci A, Wintermark P, Shalish W, Claveau M, Beltempo M. Optimizing timing and frequency of head ultrasound screening for severe brain injury among preterm infants born <32 weeks' gestation. J Matern Fetal Neonatal Med 2022; 35:10330-10336. [PMID: 36216353 DOI: 10.1080/14767058.2022.2128647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To develop a head ultrasound (HUS) screening protocol for infants born <32 weeks gestational age (GA) that accurately identifies severe brain injury (SBI) while minimizing resource use. STUDY DESIGN Retrospective cohort study of infants born <32 weeks GA, admitted to a level 3 neonatal intensive care unit between 2011 and 2017. Timing and results of each HUS were reviewed. SBI was defined as intraventricular hemorrhage grade ≥3 and/or periventricular leukomalacia. Logistic regression models were used to identify risk factors and evaluate the predictive value of HUS at different time points during hospitalization. RESULTS Of 651 included infants, 71 (11%) developed SBI. Risk factors for SBI were GA at birth <29 weeks (adjusted odds ratio (aOR) 2.87, 95% confidence interval (CI) 1.50-5.48), vasopressors on admission (aOR 3.08, 95%CI 1.38-6.88) and mechanical ventilation on admission (aOR 2.50, 95%CI 1.33-4.68). Infants were classified into three risk groups based on these risk factors, and combinations of 1-5 HUS time points were evaluated to determine the optimal number and timing of HUS for each group. The optimal number of screening HUS ranged from 1 for low-risk to 2 for high-risk infants. Adopting a screening protocol using the number and timing of HUS optimized by risk group could reduce the total number of HUS performed by 40% and the median number of HUS per infant from 3 (IQR 2-4) to 2 (IQR 1-3) (p < .01). CONCLUSIONS Implementation of a risk factor-based HUS screening protocol can help reduce resource use while maintaining high sensitivity for detecting SBI.
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Affiliation(s)
- Sharina Patel
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Andrea Martel-Bucci
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Pia Wintermark
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Wissam Shalish
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Martine Claveau
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Canada
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Busque AA, Jabbour E, Patel S, Couture É, Garfinkle J, Khairy M, Claveau M, Beltempo M. Incidence and risk factors for autism spectrum disorder among infants born <29 weeks' gestation. Paediatr Child Health 2022; 27:346-352. [PMID: 36200098 PMCID: PMC9528782 DOI: 10.1093/pch/pxac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/03/2022] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE This study was aimed to assess the incidence of and risk factors for autism spectrum disorder (ASD) among preterm infants born <29 weeks' gestational age (GA). METHODS A retrospective cohort study of infants born <29 weeks' GA admitted to two tertiary neonatal intensive care units (2009 to 2017) and followed ≥18 months corrected age (CA) at a neonatal follow-up clinic. The primary outcome was ASD, diagnosed using standardized testing or provisional diagnosis at ≥18 months CA. Patient data and 18-month CA developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and chart review. Stepwise logistic regression assessed factors associated with ASD. RESULTS Among 300 eligible infants, 26 (8.7%) were diagnosed with confirmed and 21 (7.0%) with provisional ASD for a combined incidence of 15.7% (95% confidence interval [CI] 11.7 to 20.3). The mean follow-up duration was 3.9 ± 1.4 years and the mean age of diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12 to 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02 to 9.01), maternal age ≥35 years at delivery (aOR 2.22, 95% CI 1.08 to 4.57) and smoking during pregnancy (aOR 5.67, 95% CI 1.86 to 17.29) were significantly associated with ASD. Among ASD infants with a complete 18-month CA developmental assessment, 46% (19/41) had no neurodevelopmental impairment (Bayley-III<70, deafness, blindness, or cerebral palsy). CONCLUSIONS ASD is common among infants born <29 weeks' GA and possibly associated with identified risk factors. Such findings emphasize the importance of ASD evaluation among infants <29 weeks' GA and for continued reporting of developmental outcomes beyond 18-months of corrected age.
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Affiliation(s)
| | - Elias Jabbour
- McGill University Health Center, Research Institute, Montreal, Quebec, Canada
| | - Sharina Patel
- McGill University, Montreal, Quebec, Canada
- McGill University Health Center, Research Institute, Montreal, Quebec, Canada
| | - Élise Couture
- Department of Pediatrics, Montreal Children’s Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - Jarred Garfinkle
- McGill University Health Center, Research Institute, Montreal, Quebec, Canada
- Department of Pediatrics, Montreal Children’s Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - May Khairy
- Department of Pediatrics, Montreal Children’s Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - Martine Claveau
- Department of Pediatrics, Montreal Children’s Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Beltempo
- McGill University Health Center, Research Institute, Montreal, Quebec, Canada
- Department of Pediatrics, Montreal Children’s Hospital - McGill University Health Centre, Montreal, Quebec, Canada
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30
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Le Blanc G, Jabbour E, Patel S, Kazantseva O, Zeid M, Olivier F, Shalish W, Beltempo M. Organizational Risk Factors and Clinical Impacts of Unplanned Extubation in the Neonatal Intensive Care Unit. J Pediatr 2022; 249:14-21.e5. [PMID: 35714965 DOI: 10.1016/j.jpeds.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the association between organizational factors and unplanned extubation events in the neonatal intensive care unit (NICU) and to evaluate the association between unplanned extubation event and bronchopulmonary dysplasia (BPD) among infants born at <29 weeks of gestational age. STUDY DESIGN This is a retrospective cohort study of infants admitted to a tertiary care NICU between 2016 and 2019. Nursing provision ratios, daily nursing overtime hours/total nursing hours ratio, and unit occupancy were compared between days with and days without unplanned extubation events. The association between unplanned extubation events (with and without reintubation) and the risk of BPD was evaluated in infants born at <29 weeks who required mechanical ventilation using a propensity score-matched cohort. Multivariable logistic regression analysis was used to assess the association between exposures and outcomes while adjusting for confounders. RESULTS On 108 of 1370 days there was ≥1 unplanned extubation event for a total of 116 unplanned extubation event events. Higher median nursing overtime hours (20 hours vs 16 hours) and overtime ratios (3.3% vs 2.5%) were observed on days with an unplanned extubation event compared with days without an unplanned extubation event (P = .01). Overtime ratio was associated with higher adjusted odds of a unplanned extubation event (aOR, 1.09; 95% CI, 1.01-1.18). In the subgroup of infants born at <29 weeks, those with an unplanned extubation event who were reintubated had a longer postmatching duration of mechanical ventilation (aOR, 13.06; 95% CI, 4.88-37.69) and odds of BPD (aOR, 2.86; 95% CI, 1.01-8.58) compared with those without an unplanned extubation event. CONCLUSIONS Nursing overtime ratio is associated with an increased number of unplanned extubation events in the NICU. In infants born at <29 weeks of gestational age, reintubation after an unplanned extubation event is associated with a longer duration of mechanical ventilation and increased risk of BPD.
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Affiliation(s)
| | - Elias Jabbour
- McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Sharina Patel
- McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Olga Kazantseva
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Marco Zeid
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Francois Olivier
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Wissam Shalish
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Marc Beltempo
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Center Research Institute, Montreal, Quebec, Canada; Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.
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Beltempo M, Wintermark P, Mohammad K, Jabbour E, Afifi J, Shivananda S, Louis D, Redpath S, Lee KS, Fajardo C, Shah PS. Variations in practices and outcomes of neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia across tertiary NICUs in Canada. J Perinatol 2022; 42:898-906. [PMID: 35552529 DOI: 10.1038/s41372-022-01412-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize variations in practices and outcomes for neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) across Canadian tertiary Neonatal Intensive Care Units (NICUs). STUDY DESIGN Retrospective study of neonates admitted for HIE and treated with TH in 24 tertiary NICUs from the Canadian Neonatal Network, 2010-2020. The two primary outcomes of mortality before discharge and MRI-detected brain injury were compared across NICUs using adjusted standardized ratios (SR) with 95% CI. RESULTS Of the 3261 neonates that received TH, 367 (11%) died and 1033 (37%) of the 2822 with MRI results had brain injury. Overall, rates varied significantly across NICUs for mortality (range 5-17%) and brain injury (range 28-51%). Significant variations in use of inotropes, inhaled nitric oxide, blood products, and feeding during TH were identified (p values < 0.01). CONCLUSION Significant variations exist in practices and outcomes of HIE neonates treated with hypothermia across Canada.
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Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada.
| | - Pia Wintermark
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Elias Jabbour
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Sandesh Shivananda
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Deepak Louis
- Division of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Stephanie Redpath
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Carlos Fajardo
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
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32
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Beltempo M, Bresson G, Étienne JM, Lacroix G. Infections, accidents and nursing overtime in a neonatal intensive care unit. Eur J Health Econ 2022; 23:627-643. [PMID: 34665324 DOI: 10.1007/s10198-021-01386-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
The paper investigates the effects of nursing overtime on nosocomial infections and medical accidents in a neonatal intensive care unit (NICU). The literature lacks clear evidence on this issue and we conjecture that this may be due to empirical and methodological factors. We model the occurrences of both events using a sample of 3979 neonates who represents over 84,846 observations (infant/days). We exploit an important change in workforce arrangement that was implemented in June 2012, and which aimed at reducing overtime hours to identify a causal impact between the latter and the two outcomes of interest. We contrast the results using a standard mixed-effects logit model with those of a semiparametric mixed-effects logit model. Contrary to the mixed-effects logit model, the semiparametric model unequivocally shows that both adverse events are impacted by nursing overtime as well as being highly sensitive to infant and NICU-related characteristics. Furthermore, the mixed-effects logit model is rejected in favour of the semiparametric one.
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Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montréal, QC, Canada
| | | | | | - Guy Lacroix
- Department of Economics, Université Laval, Québec, Canada.
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Debay A, Beltempo M, Czuzoj-Shulman N, Abenhaim H. Cardiopulmonary Resuscitation in Term Infants: Trends, Risk Factors, and Outcomes: A Population-Based Study. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Carvalho Nunes G, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna GM, Altit G. Natural evolution of the patent ductus arteriosus in the extremely premature newborn and respiratory outcomes. J Perinatol 2022; 42:642-648. [PMID: 34815521 DOI: 10.1038/s41372-021-01277-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/21/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Evaluate spontaneous closure of the patent ductus arteriosus (PDA) in extremely preterm infants and their respiratory outcomes, especially at <26 weeks gestational age (GA). STUDY DESIGN Retrospective study in <29 weeks, admitted within 24 h after birth (Feb 2015 and Dec 2019). Infants without any intervention to promote ductal closure, ≥1 echocardiography, and alive at discharge were included. RESULTS Two hundred and fourteen infants (average GA 26.3 ± 1.5 weeks) were included; 84 (39%) <26 weeks. PDA closed spontaneously in 194 (91%); 76/84 (90%) for infants <26 weeks. PDA closure was ascertained on an echocardiography performed at a median age of 36.4 [34.4-40.1] weeks. Rate of moderate-to-severe bronchopulmonary dysplasia decreased throughout the study period (OR for year of birth: 0.70 [95% CI: 0.57-0.87], p = 0.001). CONCLUSION Majority of extremely preterm infants, including <26 weeks, had spontaneous closure of the ductus before term corrected age. There was a concomitant improvement of respiratory outcomes.
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Affiliation(s)
- Gabriela de Carvalho Nunes
- Neonatology-McGill University Health Centre-Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Punnanee Wutthigate
- Neonatology-McGill University Health Centre-Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Jessica Simoneau
- Neonatology-McGill University Health Centre-Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Marc Beltempo
- Neonatology-McGill University Health Centre-Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Guilherme Mendes Sant'Anna
- Neonatology-McGill University Health Centre-Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Gabriel Altit
- Neonatology-McGill University Health Centre-Montreal Children's Hospital, Department of Pediatrics, McGill University, Montreal, QC, Canada.
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Debay A, Patel S, Wintermark P, Claveau M, Olivier F, Beltempo M. Association of Delivery Room and Neonatal Intensive Care Unit Intubation, and Number of Tracheal Intubation Attempts with Death or Severe Neurological Injury among Preterm Infants. Am J Perinatol 2022; 39:776-785. [PMID: 33075843 DOI: 10.1055/s-0040-1718577] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study aimed to assess the association of tracheal intubation (TI) and where it is performed, and the number of TI attempts with death and/or severe neurological injury (SNI) among preterm infants. STUDY DESIGN Retrospective cohort study of infants born 23 to 32 weeks, admitted to a single level-3 neonatal intensive care unit (NICU) between 2015 and 2018. Exposures were location of TI (delivery room [DR] vs. NICU) and number of TI attempts (1 vs. >1). Primary outcome was death and/or SNI (intraventricular hemorrhage grade 3-4 and/or periventricular leukomalacia). Multivariable logistic regression analysis was used to assess association between exposures and outcomes and to adjust for confounders. RESULTS Rate of death and/or SNI was 2.5% (6/240) among infants never intubated, 12% (13/105) among NICU TI, 32% (31/97) among DR TI, 20% (17/85) among infants with one TI attempt and 23% (27/117) among infants with >1 TI attempt. Overall, median number of TI attempts was 1 (interquartile range [IQR]: 1-2). Compared with no TI, DR TI (adjusted odds ratio [AOR]: 9.04, 95% confidence interval [CI]: 3.21-28.84) and NICU TI (AOR: 3.42, 95% CI: 1.21-10.61) were associated with higher odds of death and/or SNI. The DR TI was associated with higher odds of death and/or SNI compared with NICU TI (AOR: 2.64, 95% CI: 1.17-6.22). The number of intubation attempts (1 vs. >1) was not associated with death and/or SNI (AOR: 0.95, 95% CI: 0.47-2.03). CONCLUSION The DR TI is associated with higher odds of death and/or SNI compared with NICU TI, and may help identify higher risk infants. There was no association between the number of TI attempts and death and/or SNI. KEY POINTS · Delivery room intubation correlates with morbidity.. · Less than 2 intubation attempts are not associated with IVH.. · Provider training reduces intubation attempts..
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Affiliation(s)
- Anthony Debay
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sharina Patel
- McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Pia Wintermark
- McGill University Health Center Research Institute, Montreal, Quebec, Canada.,Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - Martine Claveau
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - François Olivier
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada
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Lemieux-Bourque C, Piedboeuf B, Gignac S, Taylor-Ducharme S, Julien AS, Beltempo M. Comparison of Three Nursing Workload Assessment Tools in the Neonatal Intensive Care Unit and Their Association with Outcomes of Very Preterm Infants. Am J Perinatol 2022; 39:640-645. [PMID: 33053592 DOI: 10.1055/s-0040-1718571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Nursing workload assessment tools are widely used to determine nurse staffing requirements in the neonatal intensive care unit (NICU). We aimed to compare three existing workload assessment tools and assess their association with mortality or morbidity among very preterm infants. STUDY DESIGN Single-center retrospective cohort study of infants born <33 weeks and admitted to a 52-bed tertiary NICU in 2017 to 2018. Required nurse staffing was estimated for each shift using the Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) used as reference tool, the Quebec Provincial NICU Nursing Ratio (QPNNR), and the Canadian NICU Resource Utilization (CNRU). Poisson regression models with robust error variance estimators were used to assess the association between nursing provision ratios (actual number of nurses/required number of nurses) during the first 7 days of admission and neonatal outcomes. RESULTS Median number of nurses required per shift using the WANNNT was 25.0 (interquartile range [IQR]: 23.1-26.7). Correlation between WANNNT and QPNNR was high (r = 0.92, p < 0.0001), but the QPNNR underestimated the number of nurses per shift by 4.8 (IQR: 4.1-5.4). Correlation between WANNNT and CNRU was moderate (r = 0.45, p < 0.0001). The NICU nursing provision ratios during the first 7 days of admission calculated using the WANNNT (adjusted risk ratio [aRR]: 0.96, 95% confidence interval [CI]: 0.93-0.99) and QPNNR (aRR: 0.97, 95% CI: 0.95-0.99) were associated with mortality or morbidity. CONCLUSION Lower nursing provision ratio calculated using the WANNNT and CNRU during the first 7 days of admission is associated with an increased risk of mortality/morbidity in very preterm infants. KEY POINTS · NICUs use different nursing workload assessment tools.. · We validated three different nursing workload assessment tools used in the NICU.. · Nursing provision ratio is associated the risk of mortality/morbidity in preterm infants..
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Affiliation(s)
- Charlotte Lemieux-Bourque
- CHU de Québec Research Center, Quebec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Bruno Piedboeuf
- CHU de Québec Research Center, Quebec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Simon Gignac
- Neonatal Intensive Care Unit, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | - Anne-Sophie Julien
- Statistical Consulting Service, Department of Mathematics and Statistics, Université Laval, Quebec, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Sabsabi B, Huet C, Rampakakis E, Beltempo M, Brown R, Lodygensky GA, Piedboeuf B, Wintermark P. Asphyxiated Neonates Treated with Hypothermia: Birth Place Matters. Am J Perinatol 2022; 39:298-306. [PMID: 32854133 DOI: 10.1055/s-0040-1715823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to assess whether the hospital level of care where asphyxiated neonates treated with hypothermia were originally born influences their outcome. STUDY DESIGN We conducted a retrospective cohort study of all asphyxiated neonates treated with hypothermia in a large metropolitan area. Birth hospitals were categorized based on provincially predefined levels of care. Primary outcome was defined as death and/or brain injury on brain magnetic resonance imaging (adverse outcome) and was compared according to the hospital level of care. RESULTS The overall incidence of asphyxiated neonates treated with hypothermia significantly decreased as hospital level of care increased: 1 per 1,000 live births (109/114,627) in level I units; 0.9 per 1,000 live births (73/84,890) in level II units; and 0.7 per 1,000 live births (51/71,093) in level III units (p < 0.001). The rate of emergent cesarean sections and the initial pH within the first hour of life were significantly lower in level I and level II units compared with level III units (respectively, p < 0.001 and p = 0.002). In a multivariable analysis adjusting for the rates of emergent cesarean sections and initial pH within the first hour of life, being born in level I units was confirmed as an independent predictor of adverse outcome (adjusted odds ratio [OR] level I vs. level III 95% confidence interval [CI]: 2.13 [1.02-4.43], p = 0.04) and brain injury (adjusted OR level I vs. level III 95% CI: 2.41 [1.12-5.22], p = 0.02). CONCLUSION Asphyxiated neonates born in level I units and transferred for hypothermia treatment were less often born by emergent cesarean sections, had worse pH values within the first hour of life, and had a higher incidence of adverse outcome and brain injury compared with neonates born in level III units. Further work is needed to optimize the initial management of these neonates to improve outcomes, regardless of the location of their hospital of birth. KEY POINTS · The incidence of asphyxiated neonates treated with hypothermia varied by hospital level of care.. · Their rates of emergent cesarean sections and their initial pH within the first hour of life varied by hospital level of care.. · The hospital level of care was an independent predictor of their adverse outcome, defined as death and/or brain injury on brain MRI..
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Affiliation(s)
- Bayane Sabsabi
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Canada
| | - Cloe Huet
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Canada
| | - Emmanouil Rampakakis
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Canada.,Medical Affairs, JSS Medical Research, Montreal, Québec, Canada
| | - Marc Beltempo
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Canada
| | - Richard Brown
- Department of Gynecology and Obstetrics, McGill University, Montreal, Quebec, Canada
| | - Gregory A Lodygensky
- Division of Newborn Medicine, Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Research Centre of the CHU de Québec, University Laval, Quebec City, Canada
| | - Pia Wintermark
- Division of Newborn Medicine, Department of Pediatrics, McGill University, Montreal, Canada
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Trahan MJ, Atallah A, Baril S, Wou K, Beltempo M, Abenhaim HA, Boucoiran I. Alternative antibiotic regimens for the management of preterm premature rupture of membranes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gurram Venkata SKR, Shah PS, Beltempo M, Yoon E, Wood S, Hicks M, Daboval T, Wong J, Wintermark P, Mohammad K. Outcomes of infants with hypoxic-ischemic encephalopathy during COVID-19 pandemic lockdown in Canada: a cohort study. Childs Nerv Syst 2022; 38:1727-1734. [PMID: 35676388 PMCID: PMC9177131 DOI: 10.1007/s00381-022-05575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate change in the severity of hypoxic-ischemic encephalopathy (HIE) and associated morbidities between pre- and during COVID-19 pandemic periods in Canada. METHODS We conducted a retrospective cohort study extracting the data from level-3 NICUs participating in Canadian Neonatal Network (CNN). The primary outcome was a composite of death in the first week after birth and/or stage 3 HIE (Sarnat and Sarnat). Secondary outcomes included rate and severity of HIE among admitted neonates, overall mortality, brain injury on magnetic resonance imaging (MRI), neonates requiring resuscitation, organ dysfunction, and therapeutic hypothermia (TH) usage. We included 1591 neonates with gestational age ≥ 36 weeks with HIE during the specified periods: pandemic cohort from April 1st to December 31st of 2020; pre-pandemic cohort between April 1st and December 31st of 2017, 2018, and 2019. We calculated the odds ratio (OR) and confidence intervals (CI). RESULTS We observed no significant difference in the primary outcome (15% vs. 16%; OR 1.08; 95%CI 0.78-1.48), mortality in the first week after birth (6% vs. 6%; OR 1.10, 95%CI 0.69-1.75), neonates requiring resuscitation, organ dysfunction, TH usage, or rate of brain injury. In the ad hoc analysis, per 1000 live births, there was an increase in the rate of infants with HIE and TH use. CONCLUSIONS Severity of HIE, associated morbidities, and mortality were not significantly different during the pandemic lockdown compared to a pre-pandemic period in Canada. Anticipated risks and difficulties in accessing healthcare have not increased the mortality and morbidities in neonates with HIE in Canada.
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Affiliation(s)
| | - Prakesh S. Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Marc Beltempo
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children’s Hospital, McGill University, Montreal, QC Canada
| | - Eugene Yoon
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
| | - Stephen Wood
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Matthew Hicks
- Department of Pediatrics, Division of Neonatal-Perinatal Care, Stollery Children’s Hospital, University of Alberta, Edmonton, AB Canada
| | - Thierry Daboval
- Department of Pediatrics, Division of Neonatology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada
| | - Jonathan Wong
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Pia Wintermark
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children’s Hospital, McGill University, Montreal, QC Canada
| | - Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, Canada. .,Department of Pediatrics, Section of Neonatology, Alberta Children's Hospital, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.
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40
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Shah PS, Joynt C, Håkansson S, Narvey M, Navér L, Söderling J, Yang J, Beltempo M, Stephansson O, Fell DB, Money D, Ting JY, Norman M. Infants Born to Mothers Who Were SARS-CoV-2 Positive during Pregnancy and Admitted to Neonatal Intensive Care Unit. Neonatology 2022; 119:619-628. [PMID: 36088904 PMCID: PMC9747725 DOI: 10.1159/000526313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our objective was to compare neonatal outcomes and resource use of neonates born to mothers with SARS-CoV-2 positivity during pregnancy with neonates born to mothers without SARS-CoV-2 positivity. METHODS We conducted a two-country cohort study of neonates admitted between January 1, 2020, and September 15, 2021, to tertiary neonatal intensive care unit (NICU) in Canada and Sweden. Neonates from mothers who were SARS-CoV-2 positive during pregnancy were compared with three randomly selected NICU neonates of mothers who were not test-positive, matched on gestational age, sex, and birth weight (±0.25 SD). Subgroup analyses were conducted for neonates born <33 weeks' gestation and mothers who were SARS-CoV-2 positive ≤10 days prior to birth. Primary outcome was duration of respiratory support. Secondary outcomes were in-hospital mortality, neonatal morbidity, late-onset sepsis, receipt of breast milk at discharge, and length of stay. RESULTS There were 163 exposed and 468 matched neonates in Canada, and 303 exposed and 903 matched neonates in Sweden. There was no statistically significant difference in invasive or noninvasive respiratory support durations, mortality, respiratory and other neonatal morbidities, or resource utilizations between two groups in both countries in entire cohort and in subgroup analyses. Receipt of breast milk at discharge was lower in the Canadian neonates of mothers who were SARS-CoV-2 positive ≤10 days before birth (risk ratio 0.68, 95% CI: 0.57-0.82). CONCLUSION Maternal SARS-CoV-2 positivity was not associated with increased durations of respiratory support, morbidities, mortality, or length of hospital stay in Canada and Sweden among neonates admitted to tertiary NICU.
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Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Mother-Infant Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Chloe Joynt
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Stellan Håkansson
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Michael Narvey
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lars Navér
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Junmin Yang
- Mother-Infant Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital-McGill University Health Centre, Montreal, Québec, Canada
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Deborah Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Y Ting
- Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Grabovac M, Beltempo M, Lodha A, O'Quinn C, Grigoriu A, Barrington K, Yang J, McDonald SD. Impact of Deferred Cord Clamping on Mortality and Severe Neurologic Injury in Twins Born at <30 Weeks of Gestation. J Pediatr 2021; 238:118-123.e3. [PMID: 34332971 DOI: 10.1016/j.jpeds.2021.07.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/29/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether deferred cord clamping (DCC) compared with early cord clamping (ECC) was associated with reduction in death and/or severe neurologic injury among twins born at <30 weeks of gestation. STUDY DESIGN We performed a retrospective cohort study including all liveborn twins of <30 weeks admitted to a tertiary-level neonatal intensive care unit (NICU) in Canada between 2015 and 2018 using the Canadian Neonatal/Preterm Birth Network database. We compared DCC ≥30 seconds vs ECC <30 seconds. Our primary outcome was a composite of death and/or severe neurologic injury (severe intraventricular hemorrhage grade III/IV and/or periventricular leukomalacia). Secondary outcomes included neonatal morbidity and health care utilization outcomes. We calculated aORs and β coefficients for categorical and continuous variables, along with 95% CI. Models were fitted with generalized estimated equations accounting for twin correlation. RESULTS We included 1597 twins (DCC, 624 [39.1%]; ECC, 973 [60.9%]). Death/severe neurologic injury occurred in 17.8% (n = 111) of twins who received DCC and in 21.7% (n = 211) of those who received ECC. The rate of death/severe neurologic injury did not differ significantly between the DCC and ECC groups (aOR 1.07; 95% CI, 0.78-1.47). DCC was associated with reduced blood transfusions (adjusted β coefficient, -0.49; 95% CI, -0.86 to -0.12) and NICU length of stay (adjusted β coefficient, -4.17; 95% CI, -8.15 to -0.19). CONCLUSIONS The primary composite outcome of death and/or severe neurologic injury did not differ between twins born at <30 weeks of gestation who received DCC and those who received ECC, but DCC was associated with some benefits.
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Affiliation(s)
- Marinela Grabovac
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
| | - Marc Beltempo
- Department of Pediatrics, Montreal's Children's Hospital-McGill University Health Centre, Montréal, Québec, Canada
| | - Abhay Lodha
- Department of Pediatrics and Community Health Sciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Candace O'Quinn
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Ariadna Grigoriu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Keith Barrington
- Department of Pediatrics, University of Montréal, Montréal, Québec, Canada
| | - Junmin Yang
- Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; Division of Maternal Fetal Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Radiology, McMaster University, Hamilton, Ontario, Canada
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Rizzolo A, Shah PS, Bertelle V, Makary H, Ye XY, Abenhaim HA, Piedboeuf B, Beltempo M. Association of timing of birth with mortality among preterm infants born in Canada. J Perinatol 2021; 41:2597-2606. [PMID: 34050244 DOI: 10.1038/s41372-021-01092-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the association between time of birth and mortality among preterm infants. STUDY DESIGN Population-based study of infants born 22-36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. RESULT Among infants 22-27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01-1.29). Among infants 28-32 weeks GA and 33-36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59-0.95; AOR 0.78, 95% CI 0.62-0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28-32 and 33-36 weeks GA decreased or were not statistically significant. CONCLUSION Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.
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Affiliation(s)
- Angelo Rizzolo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Prakesh S Shah
- Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Valerie Bertelle
- Department of Pediatrics, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Hala Makary
- Department of Pediatrics, Dr. Everett Chalmers Hospital, Fredericton, NB, Canada
| | - Xiang Y Ye
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Université Laval, Quebec, QC, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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de Carvalho Nunes G, Wutthigate P, Simoneau J, Beltempo M, Sant'Anna G, Altit G. 10 High spontaneous ductal closure even at the extreme of prematurity. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Extremely preterm newborns are at risk of prolonged patency of the ductus arteriosus (PDA). Current literature has failed to indicate improvement in outcomes after exposure to strategies promoting ductal closure. As such, our center abandoned these practices in 2013.
Objectives
Describe the spontaneous PDA closure in premature infants, including those infants born at the extreme of gestational age (< 26 weeks).
Design/Methods
Retrospective study of newborns < 29 weeks, admitted within 24 hours after birth between 2015 and 2019 and without genetic or congenital anomalies. Newborns who were last known to be alive, with an available echocardiography, and who were not exposed to any intervention to accelerate PDA closure were included. Images were reviewed by experts blinded to the outcomes.
Results
296 infants were analyzed. 37 (12%) did not survive their hospitalization, and 16 were exposed to interventions to accelerate ductal closure at some point during their lifetime (4 ligations, 4 catheter-closure, 5 ibuprofen and 3 acetaminophen). Out of the 243 remaining newborns, 214 had at least one echocardiography to ascertain ductal patency or closure (100% of those <26 weeks). The average gestational age was 26.3±1.5 weeks, with 84 (39%) being <26 weeks. PDA closed spontaneously in 194 (91%), with 60 having closure ascertainment after discharge (average age at closure ascertainment of 36.4 [IQR: 34.4 – 40.1] weeks). Of the 84 <26 weeks, 76 (90%) had confirmation of ductal closure. The 20 infants with an open PDA at the last evaluation were followed in an outpatient setting and considered small/restrictive. In our cohort, 92/243 (38%) were exposed to post-natal steroids. In the <26 weeks group, 74% were exposed to steroids, at a cumulative dose of 1.64 [0.89 – 2.44] mg/kg. BPD was found in 57% of the overall cohort and in 79% of <26 weeks.
Conclusion
The majority of newborns < 29 weeks, and even those at the extreme of gestational age (< 26 weeks) spontaneously closed their PDA before term-corrected age. While BPD rate was similar to previous cohorts, post-natal steroids use was high.
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Beltempo M, Platt R, Julien AS, Blais R, Valerie B, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B. 67 Are NICUs too busy? Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
In a health care system with limited resources, hospital organizational factors such as unit occupancy and nurse-to-patient ratios may contribute to patient outcomes.
Objectives
We aimed to assess the association of NICU occupancy and nurse staffing with outcomes of very preterm infants born < 33 weeks gestational age (GA).
Design/Methods
This was a multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted within 2 days after birth to one of four Level 3 NICUs in Quebec, Canada (2015-2018). For each 8 h shift, data on unit occupancy were obtained from a central provincial database (SiteNeo) and linked to the hospital nursing hours database (Logibec). Unit occupancy rates and nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) were pooled for the first shift, 24 h, and 7 days of admission for each infant. Patient data were obtained from the Canadian Neonatal Network database. Primary outcome was mortality and/or morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, and late-onset sepsis, severe retinopathy of prematurity). Adjusted odds ratios (AOR) for association of exposure with outcomes were estimated using generalized linear mixed models with a random effect for center, while adjusting for confounders (gestational age, small for gestational age, sex, outborn, Score for Neonatal Acute Physiology version 2, mode of delivery, and the other organizational variables).
Results
Among 1870 infants included in analyses, 796 (43%) had mortality/morbidity. Median occupancy was 89% (IQR 82-94) and median nursing provision was 1.13 (IQR 0.97-1.37). Overall higher NICU occupancy on shift of admission, first 24 h, and 7 days were associated with higher odds of mortality/morbidity (Figure 1) but nursing provision was not (Figure 2). Subgroup analysis by GA (< 29 and 29-32 weeks) yielded similar results (not shown). Generalized linear mixed model analyses showed that a 5% reduction in occupancy in the first 24 h of admission was associated with a 6% reduction in mortality/morbidity.
Conclusion
NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.
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Ng LLC, Beltempo M, Patel S, Paquette K, Filion-Ouellet E, Plourde H, Besner ME. 60 Impact of sequential implementation of a standardized feeding protocol and donor breastmilk on necrotizing enterocolitis among preterm infants born <31 weeks gestation. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal morbidity and mortality among preterm infants born <31 weeks. Nutritional interventions such as a standardized feeding protocol (SFP) and donor breastmilk (DBM) are recommended to reduce NEC.
Objectives
Our objective was to assess the impact of implementing a feeding protocol and pasteurized donor breastmilk protocol on NEC among preterm infants born < 31 weeks GA.
Design/Methods
Retrospective cohort study including 682 infants born < 31 weeks, who survived ≥ 14 days and were admitted to two tertiary NICUs from 2009-2018. Data was obtained from the local Canadian Neonatal Network database. Infants were classified into epochs, based on the timing of interventions: Epoch 1, baseline (2009-2012); Epoch 2, SFP (2013-2015); Epoch 3, SFP + DBM (2016-2018). The primary outcome was NEC stage ≥ 2. Multivariable logistic regression models were used to assess associations between epochs and outcomes and were adjusted for confounders.
Results
Among 682 infants, 46 (7%) had NEC and 74 (11%) had mortality/NEC. Rates of NEC decreased with each epoch: 10% (25/246) Epoch 1 (baseline); 5% (8/163) Epoch 2 (SFP); and 5% (13/273) Epoch 3 (SFP+DBM), (p<0.01) (Table1). SFP alone was associated with significantly lower odds of NEC compared to baseline (Epoch 2 vs 1, AOR 0.42, 95% CI 0.17-0.93) (Table 2). Implementation of DBM was not associated with lower odds of NEC compared to SFP alone (Epoch 3 vs 2, AOR 0.94, 95% CI 0.38-2.42) (Table2). Number of NPO days prior to the initiation of enteric feeds after birth decreased in Epoch 3 (Epoch 1&2: 2 days versus Epoch 3: 1 day; p<0.01). Exclusive human breastmilk feeds during the first 3 weeks increased from 62% in Epoch 2 to 82% in Epoch 3 (p<0.01). A significant decrease in number of total parenteral nutrition and central venous line (CVL) days was observed from Epoch 1 to 3 (25 to 15 days and 26 to 15 days respectively; p<0.01) (Table 1), this was reflected in the decrease in late onset sepsis (Epoch 3 vs 1, AOR 0.55, 95% CI 0.35-0.86).
Conclusion
Implementation of SFP was associated with a significant decrease in NEC among infants born < 31 weeks. Combining the SFP and DBM did not further decrease NEC, but was associated with shorter NPO days, higher exclusive human breastmilk exposure, and significant decrease in number of central venous line (CVL) days.
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Debay A, Shah P, Lodha A, Shivananda S, Redpath S, Seshia M, Dorling J, Lapointe A, Canning R, Strueby L, Beltempo M. 64 Association of 24-hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Medical team composition at the delivery of high-risk neonates may contribute to better outcomes. The presence of 24-hour (h) in-house staff neonatologist (NN) may improve delivery room (DR) care practices and outcomes.
Objectives
To assess if 24-h in-house NN coverage is associated with better care practices and outcomes among inborn infants born < 29 weeks GA.
Design/Methods
Cross-sectional cohort study of 2476 inborn infants born at 23-28 weeks gestation, admitted in 2014-2015 to Canadian Neonatal Network level 3 NICUs with a maternity unit that participated in a 2015 survey on NICU coverage. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders with generalized estimating equations to account for clustering within each site.
Results
Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). Infants’ characteristics are shown in Table 1. No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving DR chest compressions or epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively) (Table 2). 24-h fellow coverage was associated with higher odds of normothermia (36.5°C-37.2°C) on admission (AOR 2.26, 95% CI 1.51-3.37) compared to 24-h NN coverage (Table 2). Rates of mortality or major morbidity did not differ significantly among the three groups: NN, 63% (249/395); fellow, 64% (1092/1700); no NN/fellow, 70% (266/381). Compared to 24-h NN coverage, 24-h fellow coverage was associated with lower odds of mortality (AOR 0.62, 95% CI, 0.43-0.88) (Table 2).
Conclusion
24-h in-house NN coverage was associated with lower rates of DR chest compressions or epinephrine use; however, it was not associated with death and/or major morbidity. These results are from a survey linked cohort, and data on the actual presence of individuals in NICU/resuscitation is unknown. Future prospective research on care providers present in the NICU, and its impact on outcomes, is needed.
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Jabbour E, Patel S, Rios JD, Pechlivanoglou P, Shah P, Beltempo M. 87 Validation of a Costing Algorithm in the Neonatal Intensive Care Unit and Identification of Cost Drivers for Neonates. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Neonatal Intensive Care Units (NICUs) account for over 35% of pediatric in-hospital clinical costs, thus implying that a better understanding of care expenditures within these units is the first step for improving efficiency of care. The Canadian Neonatal Network (CNN) algorithm is the first to provide case-specific costs based on resource usage among preterm infants born < 37 weeks but has not yet been validated for other populations in the NICU.
Objectives
To validate the CNN costing algorithm in six case-mix categories with real-time costs obtained from hospital-specific financial software (CPSS) in a tertiary-level NICU and assess the variations in proportion of cost centers across case-mixes.
Design/Methods
A retrospective cohort study of all patients admitted within 24h of birth to a Level 3 medico-surgical NICU 2016-2019. Patient demographics, clinical information and CNN predicted costs were obtained from the CNN database. Real-time costs were obtained from the hospital financial software (CPSS). Total and daily costs were compared between sources using Pearson correlation coefficient (r) and paired Student’s t-test. Costs were adjusted to account for inter-institutional and -provincial price variations using the Cost of Standard Hospitalization Stay from the Canadian Institute for Health Information. Proportions of each cost center across the different case-mix categories were compared using Chi-square analyses.
Results
Among the 1795 live infants admitted into the NICU, 167 (9.3%) were < 29 weeks gestational age (GA), 193 (11%) were 29-32 weeks GA, 457 (25.5%) were 33-36 weeks GA, 144 (8%) had major congenital anomalies, 179 (10%) were term infants diagnosed with Hypoxic-Ischemic Encephalopathy (HIE) and 672 (37%) were term infants with no HIE or major congenital anomalies. Median NICU costs varied according to each case-mix from $10,025 for term infants without HIE or congenital anomaly to $180,145 for infants born < 29 weeks (Figure 1). Despite high variation in total NICU costs, there were small variations in median daily costs (range: $1,312-$1,941). Overall, the CNN algorithm strongly correlated with CPSS total costs across all 6 case-mix categories (r range 0.90-1.00, p-value < 0 .01) (Figure 2). We report a consistent strong predictive performance of the algorithm in 5/8 pre-specified cost centers among preterm infants (r range 0.77-0.99, p-value < 0 .01). Unit producing personnel (nurses and physicians) consistently comprised the largest proportion of total costs (64-78%) for all case-mix categories.
Conclusion
The CNN algorithm accurately predicts NICU total costs for six case-mix categories. Costs per day were comparable across different case-mix categories, and unit producing personnel represented the highest proportion of costs suggesting that reductions in length of stay would be the most efficient method to reduce NICU costs.
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Busque AA, Jabbour E, Patel S, Couture É, Garfinkle J, Khairy M, Claveau M, Beltempo M. 72 Identifying Perinatal and Neonatal Factors Associated with Autism Spectrum Disorder among Preterm Infants Born < 29 Weeks’ Gestation. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Preterm infants born <29 weeks’ gestational age (GA) are at risk for autism spectrum disorder (ASD), typically diagnosed at age >2 years. Perinatal and neonatal factors, including interventions and morbidities during neonatal intensive care unit admission, may contribute to the risk of ASD among these infants.
Objectives
We aimed to assess the incidence of and risk factors for, ASD among preterm infants born < 29 weeks’ GA.
Design/Methods
<29 weeks’ GA admitted 2009-2017 to two tertiary NICUs and followed ≥18 months at the Neonatal Follow-Up Clinic. Primary outcome was ASD defined as a confirmed diagnosis using standardized testing or suspected diagnosis at >18 months of corrected age. Patient data and 18-month developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and from chart review. Stepwise logistic regression was used to identify significant perinatal, neonatal, and socio-economic factors associated with ASD.
Results
Among 300 eligible infants, 47 (15.7%) developed ASD (Figure 1, Table 1). Mean follow-up duration was 3.9 ± 1.4 years and mean age at diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12, 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02, 9.01), maternal age ≥ 35 years at delivery (aOR 2.22, 95% CI 1.08, 4.57), and tobacco use in utero (aOR 5.67, 95% CI 1.86, 17.29) were significantly associated with ASD. Major neonatal morbidities (retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis, severe neurological injury) were not associated with ASD. Among infants with a complete 18-month corrected age developmental assessment and later diagnosed with ASD, 46% (19/41) did not have significant neurodevelopment impairment (Bayley-III < 70, deafness, blindness, or cerebral palsy).
Conclusion
ASD is a significant morbidity among infants born < 29 weeks’ GA. ASD was associated with infant and prenatal risk factors but not with neonatal morbidities or socio-economic factors. These findings emphasize the need for ASD evaluation among preterm infants < 29 weeks and for reporting developmental outcomes beyond 18-months corrected age.
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Affiliation(s)
| | | | | | | | | | - May Khairy
- Montreal Children’s Hospital – McGill University Health Centre
| | - Martine Claveau
- Montreal Children’s Hospital – McGill University Health Centre
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Patel S, Martel-Bucci A, Wintermark P, Shalish W, Claveau M, Beltempo M. 93 Timing and frequency of head ultrasound screening to identify severe neurological injury among very preterm infants. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Universal head ultrasound (HUS) screening for severe neurological injury (SNI) injury is recommended for infants born < 32 weeks’ gestational age (GA). However, the risk of SNI varies inversely with GA at birth and other known risk factors; therefore targeted screening may be more appropriate.
Objectives
The objective of the study is to develop a risk-stratified HUS screening protocol for infants born < 32 weeks’ to identify SNI accurately while minimizing resource use.
Design/Methods
Retrospective cohort study of infants born 23-31 weeks’ admitted to a tertiary NICU between 2011-2017. Patient characteristics were extracted from the Canadian Neonatal Network database. All HUS were individually reviewed by a trained abstractor and grouped based on date of exam relative to birth: ≤ 3 days, 4-7 days, 8-14 days, 28-42 days and 35-42 weeks’ corrected GA. Severe neurological injury was defined as intraventricular hemorrhage grade ≥ 3 and/or periventricular leukomalacia on HUS. Logistic regression models were used to identify perinatal risk factors for SNI and determine the number and timing of HUS with highest diagnostic accuracy.
Results
Of 651 infants included, 72 (11%) developed SNI. Independent risk factors for SNI were GA <29 weeks (AOR 3.09, 95% CI 1.65-6.08), vasopressors (AOR 2.95, 95% CI 1.24-6.80) and mechanical ventilation on day of admission (AOR 2.22, 95% CI 1.23-4.11). Infants were grouped into three screening groups based on their exposure to these risk factors (Table 1). Diagnostic accuracy of 63 models of combinations of HUS time points were assessed, and a screening protocol was developed based on the specific time points of HUS that maximized diagnostic accuracy (area under the ROC curve >0.9) while minimizing number of HUS for each screening group (Table 2). Using this protocol could reduce the total number of HUS performed by 920 (40%) and median number of HUS per infant from three (IQR 2-4) to 2 (IQR 1-2; p < 0 .001).
Conclusion
Implementation of a risk factor-based HUS screening protocol may reduce resource use while maintaining high diagnostic accuracy for SNI, and reflects choosing wisely in the NICU.
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Le Blanc G, Jabbour E, Patel S, Zeid M, Shalish W, Kazansteva O, Beltempo M. 63 Characterizing Organizational Risk Factors and Clinical Impacts of Unplanned Extubations among Infants in the Neonatal Intensive Care Unit. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Organizational factors in neonatal intensive care units (NICUs) can increase the risk of adverse events, such as unplanned extubations (UPEs). UPE is the premature and unanticipated removal of an endotracheal tube. UPE and subsequent reintubation may increase the risk for lung injury and bronchopulmonary dysplasia (BPD) among preterm infants.
Objectives
First, we aimed to assess the association between daily nursing overtime and UPEs in the NICU. Second, we aimed to evaluate the association between UPE, re-intubation after UPE, and BPD in the sub-group of infants born < 29 weeks’ gestational age (GA).
Design/Methods
We conducted a retrospective cohort study including infants admitted to a tertiary care NICU between 2016-2019. Daily nursing hours were obtained from local administrative databases. Patient data was collected from the local Canadian Neonatal Network database. Association between ratio of daily nursing overtime hours/total nursing hours (OTR) was compared between days with and without UPEs, using logistic regression analyses. Associations between UPE and BPD among infants born <29 weeks requiring mechanical ventilation was evaluated in a 1:1 propensity-score matched (PSM) cohort. Infants were matched based on GA ± 2 weeks, mechanical ventilation days at time of UPE ± 5 days and SNAPII>20.
Results
There were 108/1370 (7.8%) days with ≥ 1 UPE, for a total of 116 UPE events from 87 patients (23-42 weeks GA). Higher median OTR was observed on days with UPE compared to days without (3.3% vs. 2.5%, p=0.01). OTR was associated with higher adjusted odds of UPE (aOR 1.09, 95% CI 1.01-1.18), while other organizational variables were not (Table 1). Among ventilated infants <29 weeks’ GA (n=XX), UPE rate was 31% (59), BPD rate was 42% (81) and re-intubation rate after UPE was 59% (35). In the PSM cohort of infants <29 weeks, re-intubation after UPE, was associated with increased length of mechanical ventilation (aOR 16.45; CI 6.18, 26.72) as well as increased odds of BPD, when compared to infants not requiring re-intubation (aOR 4.97, 95% CI 1.54-18.27) (Table 2).
Conclusion
Higher nursing overtime was associated with increased UPEs in the NICU. Re-intubation was frequently required after a UPE. Among the infants born < 29 weeks’ GA, UPE requiring reintubation was associated with increased total length of mechanical ventilation and increased risk of BPD. Our findings highlight the role of workforce management in improving outcomes in the NICU, through reducing the incidence of UPEs.
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Affiliation(s)
| | | | - Sharina Patel
- McGill University Francois Olivier Montreal Children’s Hospital
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