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Ognean ML, Coțovanu B, Teacoe DA, Radu IA, Todor SB, Ichim C, Mureșan IC, Boicean AG, Galiș R, Cucerea M. Identification of the Best Predictive Model for Mortality in Outborn Neonates-Retrospective Cohort Study. Healthcare (Basel) 2023; 11:3131. [PMID: 38132020 PMCID: PMC10743250 DOI: 10.3390/healthcare11243131] [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: 10/07/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Transportation of sick newborns is a major predictor of outcome. Prompt identification of the sickest newborns allows adequate intervention and outcome optimization. An optimal scoring system has not yet been identified. AIM To identify a rapid, accurate, and easy-to-perform score predictive for neonatal mortality in outborn neonates. MATERIAL AND METHODS All neonates admitted by transfer in a level III regional neonatal unit between 1 January 2015 and 31 December 2021 were included. Infants with congenital critical abnormalities were excluded (N = 15). Gestational age (GA), birth weight (BW), Apgar score, place of birth, time between delivery and admission (AT), early onset sepsis, and sick neonatal score (SNS) were collected from medical records and tested for their association with mortality, including in subgroups (preterm vs. term infants); GA, BW, and AT were used to develop MSNS-AT score, to improve mortality prediction. The main outcome was all-cause mortality prediction. Univariable and multivariable analysis, including Cox regression, were performed, and odds ratio and hazard ratios were calculated were appropriate. RESULTS 418 infants were included; 217/403 infants were born prematurely (53.8%), and 20 died (4.96%). Compared with the survivors, the non-survivors had lower GA, BW, and SNS scores (p < 0.05); only the SNS scores remained lower in the subgroup analysis. Time to admission was associated with an increased mortality rate in the whole group and preterm infants (p < 0.05). In multiple Cox regression models, a cut-off value of MSNS-AT score ≤ 10 was more precise in predicting mortality as compared with SNS (AUC 0.735 vs. 0.775) in the entire group and in the preterm infants group (AUC 0.885 vs. 0.810). CONCLUSIONS The new MSNS-AT score significantly improved mortality prediction at admission in the whole study group and in preterm infants as compared with the SNS score, suggesting that, besides GA and BW, AT may be decisive for the outcome of outborn preterm infants.
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Affiliation(s)
- Maria Livia Ognean
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Bianca Coțovanu
- Department of Neonatology, Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania;
| | - Dumitru Alin Teacoe
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
- Department of Neonatology, Clinical County Emergency Hospital Sibiu, 550245 Sibiu, Romania;
| | - Ioana Andrada Radu
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Iris Codruța Mureșan
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Adrian-Gheorghe Boicean
- Faculty of Medicine, Lucian Blaga University Sibiu, 550169 Sibiu, Romania; (M.L.O.); (S.B.T.); (C.I.); (I.C.M.); (A.-G.B.)
| | - Radu Galiș
- Department of Neonatology, Clinical County Emergency Hospital Bihor, 410167 Oradea, Romania;
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania;
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania;
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Cho IY, Lee HM, Kim SY, Kim ES. Impact of Outborn/Inborn Birth Status of Infants Born at <29 Weeks of Gestation on Neurodevelopmental Impairment: A Nationwide Cohort Study in Korea. Int J Environ Res Public Health 2022; 19:11718. [PMID: 36141991 PMCID: PMC9517045 DOI: 10.3390/ijerph191811718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
This study designed to evaluate the short- and long-term outcomes of outborn and inborn preterm infants enhancing the regional perinatal system in South Korea. It is a prospective cohort study of the Korean neonatal network database for infants born at <29 weeks of gestation between 2013 and 2015. Of 2995 eligible infants, 312 were outborn, and 976 completed the assessment of long-term outcome at 18-24 months of corrected age. The mean gestational age was significantly younger in outborn infants than in inborn infants (p = 0.004). The mean Apgar score at 5 min was higher in inborn infants (p = 0.046). More inborn preterm infants died before discharge (p < 0.001); however, most of the other short-term outcomes occurred significantly more often in outborn infants than in inborn infants. The outborn infants had higher odds of neurodevelopmental impairment (adjusted odds ratio (aOR) 2.412, 95% confidence interval (CI) 1.585-3.670), cerebral palsy (aOR 4.460, 95% CI 2.249-8.845) and developmental impairment (aOR 2.238, 95% CI 1.469-3.408). In preterm infants, the location of birth may be a key factor influencing short- and long-term outcomes. Thus, to provide adequate care and efficiently allocate medical resources to high-risk preterm infants, nationwide regional perinatal systems need to be improved and standardized.
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Affiliation(s)
- In Young Cho
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Hye Mi Lee
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Sae Yun Kim
- Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
| | - Eun Sun Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon 24341, Korea
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Gul R, Anwar Z, Sheikh M, Salamat A, Iqbal S, Saleem F, Fatima S. Neonatal AKI profile using KDIGO guidelines: A cohort study in tertiary care hospital ICU of Lahore, Pakistan. Front Pediatr 2022; 10:1040077. [PMID: 36568426 PMCID: PMC9768174 DOI: 10.3389/fped.2022.1040077] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Acute kidney injury (AKI) was observed in sick neonates and was associated with poor outcomes. Our cohort represents the neonatal characteristics of those diagnosed with AKI using Kidney Disease: Improved Global Outcome (KDIGO) guidelines. METHODOLOGY A cohort study was conducted in the NICU of FMH from June 2019 to May 2021. Data were collected on a proforma. All continuous variables were not normally distributed and expressed as the median and interquartile range. Categorical variables were analyzed by proportional differences with the Pearson chi-square test or Fisher's exact tests. A multinomial logistic regression model was used to explore the independent risk factors for AKI. Time to the event (death) and the cohort's survival curves were plotted using the Cox proportional hazard model. RESULTS AKI occurred in 473 (37.6%) neonates. The risk factors of AKI were outborn birth [adjusted odds ratio (AOR): 3.987, 95% confidence interval (CI): 2.564-6.200, p: 0.000], birth asphyxia (AOR: 3.567, 95% CI: 2.093-6.080, p: 0.000), inotropic agent (AOR: 2.060, 95% CI: 1.436-2.957, p: 0.000), antenatal steroids (AOR: 1.721, 95% CI: 1.213-2.443, p: 0.002), central lines (AOR: 1.630, 95% CI: 1.155-2.298, p: 0.005) and intraventricular hemorrhage (IVH)/intracranial hemorrhage/disseminated intravascular coagulopathy (AOR: 1.580, 95% CI: 1.119-2.231, p: 0.009). AKI significantly increases the duration of stay and mortality rates by 16.5% vs. 3.9% in neonates with normal renal function (p < 0.001). CONCLUSION About one-third of critically sick neonates had AKI. Significant risk factors for AKI were outborn birth, asphyxia inotropic agents, necrotizing enterocolitis, antenatal steroids central lines, and IVH. AKI is associated with an increased length of stay and increased mortality.
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Affiliation(s)
- Rafia Gul
- Neonatal Intensive Care Unit, Fatima Memorial Hospital, Lahore, Pakistan
| | - Zahid Anwar
- Neonatal Intensive Care Unit, Fatima Memorial Hospital, Lahore, Pakistan
| | - Mehmood Sheikh
- Neonatal Intensive Care Unit, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Ayesha Salamat
- Neonatal Intensive Care Unit, Fatima Memorial Hospital, Lahore, Pakistan
| | - Samer Iqbal
- Neonatal Intensive Care Unit, Fatima Memorial Hospital, Lahore, Pakistan
| | - Furqan Saleem
- Neonatal Intensive Care Unit, Fatima Memorial Hospital, Lahore, Pakistan
| | - Samer Fatima
- Department of Psychology, Ripah International University, Lahore, Pakistan
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Kumar J, Kumar P, Saini SS, Sundaram V, Mukhopadhyay K, Dutta S, Paulpandian RR, Mittal P, Das S, Rameshbabu M, Mandula PP, Ranjan A, Tiwari D, Taneja M, Garg A, Jayashree M, Goyal K, Singh M, Puri GD, M Lakshmi PV, Guru RR. Clinical characteristics & outcome of SARS-CoV-2 infected neonates presenting to paediatric emergency. Indian J Med Res 2022; 155:189-196. [PMID: 35859443 PMCID: PMC9552379 DOI: 10.4103/ijmr.ijmr_461_21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background & objectives Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
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Affiliation(s)
- Jogender Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Praveen Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shiv Sajan Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Venkataseshan Sundaram
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Raja Rajan Paulpandian
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Piyush Mittal
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Swati Das
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Monisha Rameshbabu
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Phani Priya Mandula
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankit Ranjan
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepika Tiwari
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Manish Taneja
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashok Garg
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Murlidharan Jayashree
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mini Singh
- Department of Virology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Hospital Administration, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rashmi Ranjan Guru
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Caudéran C, Charpentier MF, Cartron E. [The support of the paediatric nurse in the paediatric emergency rapid response unit]. Soins Pediatr Pueric 2021; 42:40-43. [PMID: 34266559 DOI: 10.1016/j.spp.2021.05.010] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
When a newborn baby is in need of rapid care outside the hospital where the mother has given birth, the nursery nurses work specifically to support the baby during the separation from its parents. They intervene before, during and after the separation of mother and child, particularly during the transfer of the baby to the mobile paediatric emergency and resuscitation unit.
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Affiliation(s)
- Charlotte Caudéran
- Hôpital femme-enfant-adolescent, CHU de Nantes, 38 boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
| | - Marie-Françoise Charpentier
- Institut de formation des infirmiers spécialisés, CHU de Nantes, 50 route de Saint-Sébastien, 44200 Nantes, France
| | - Emmanuelle Cartron
- Direction de la recherche et de l'innovation, CHU de Nantes, UMR Inserm 1246-SPHERE, Université de Nantes, 5 allée de l'Île-Gloriette, 44093 Nantes cedex 1, France
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Chen WH, Su CH, Lin LC, Lin HC, Lin YJ, Hsieh HY, Sheen JM, Lee CT. Neonatal mortality among outborn versus inborn babies. Pediatr Neonatol 2021; 62:412-418. [PMID: 33967008 DOI: 10.1016/j.pedneo.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/04/2020] [Revised: 02/20/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Most previous studies reported there were higher survival rates if low birth weight babies were born in tertiary perinatal centers (inborn) than elsewhere (outborn). The objective of this study is to examine whether the number and ratio of outborn babies decrease and the neonatal mortality differs between inborn and outborn babies. METHODS We used the pooled data of the Taiwan Clinical Effectiveness Index for the years 2011-2016 obtained from the Joint Commission of Taiwan to study the outborn/inborn number and neonatal mortality rate. RESULTS We found that the number of outborn babies did not decrease year by year. The ratio of outborn to total babies was lower in the groups of birth body weight 750-999 g and ≧ 2500 g than the other groups. The neonatal mortality rate in outborns was significantly higher than the inborns in the groups of birth body weight 1000-1499 g, 2000-2499 g and ≧ 2500 g (6.9 ± 2.4 vs. 3.8 ± 0.9, P = 0.009, 2.6 ± 0.6 vs. 0.6 ± 0.3, P = 0.002 and 1.52 ± 0.67 vs. 0.08 ± 0.02, P = 0.002, respectively) in medical centers. CONCLUSION Improved maternal transport which promotes in utero transfer of patients may further improve neonatal outcome.
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Affiliation(s)
- Wan-Hsuan Chen
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Chung-Hao Su
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Li-Chun Lin
- Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ying-Jui Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Yi Hsieh
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan; Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chien-Te Lee
- Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Kusuda S, Bennett M, Gould J. Outcomes of Infants with Very Low Birth Weight Associated with Birthplace Difference: A Retrospective Cohort Study of Births in Japan and California. J Pediatr 2021; 229:182-190.e6. [PMID: 33058856 DOI: 10.1016/j.jpeds.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity. STUDY DESIGN Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California). RESULTS Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity. CONCLUSIONS Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes.
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Affiliation(s)
- Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan.
| | - Mihoko Bennett
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
| | - Jeffrey Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics Stanford University School of Medicine, CA
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Pan S, Jiang S, Lin S, Lee SK, Cao Y, Lin Z. Outcome of very preterm infants delivered outside tertiary perinatal centers in China: a multi-center cohort study. Transl Pediatr 2021; 10:306-314. [PMID: 33708516 PMCID: PMC7944173 DOI: 10.21037/tp-20-232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To describe the incidence of outborns among very preterm infants (VPIs, <32 weeks of gestation) in Chinese perinatal centers and to examine the association of outborn status with adverse outcomes. METHODS A cohort study enrolling all VPIs admitted to 18 perinatal centers in China from May 1st, 2015 to April 30th, 2018. Neonatal outcomes including rates of discharge against medical advice (DAMA), in-hospital mortality, overall mortality, severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and severe retinopathy of prematurity (ROP) were compared between outborn and inborn infants. A multivariate logistic regression model was used to estimate the independent association of outborn status with neonatal outcomes. RESULTS Among 12,014 VPIs, 1,991 (16.6%) infants were outborn. Outborn infants had lower Apgar scores and higher illness severity score on admission. Mothers of outborn infants were less likely to receive antenatal steroids, prenatal care and caesarean section. The incidence of DAMA (18.0% vs. 12.5%, P<0.001), overall mortality (19.9% vs. 15.8%, P<0.001) and severe brain injury (10.8% vs. 9.1%, P=0.024) of outborn infants were significantly higher than inborn infants. Outborn status was independently associated with increased risks of DAMA (aOR, 1.6; 95% CI: 1.4-1.8), overall-hospital mortality (aOR, 1.3; 95% CI: 1.1-1.5) and severe IVH/PVL (aOR, 1.2; 95% CI: 1.0-1.5). CONCLUSIONS The incidence of outborn VPIs was high in China. Outborn infants were more likely to be delivered in an uncontrolled situation and were at significantly higher risk of neonatal mortality and severe brain injury compared with inborn infants. Quality improvement efforts are needed to facilitate in-utero transfer of high-risk pregnancies to tertiary centers.
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Affiliation(s)
- Shulin Pan
- Department of Neonatology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Su Lin
- Department of Neonatology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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Sasaki Y, Ishikawa K, Yokoi A, Ikeda T, Sengoku K, Kusuda S, Fujimura M. Short- and Long-Term Outcomes of Extremely Preterm Infants in Japan According to Outborn/Inborn Birth Status. Pediatr Crit Care Med 2019; 20:963-9. [PMID: 31232855 DOI: 10.1097/PCC.0000000000002037] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Outborn (born outside tertiary centers) infants, especially extremely preterm infants, are at an increased risk of mortality and morbidity in comparison to inborn (born in tertiary centers) infants. Extremely preterm infants require not only skilled neonatal healthcare providers but also highly specialized equipment and environment surroundings. Maternal transport at an appropriate timing must be done to avoid the delivery of extremely preterm infants in a facility without the necessary capabilities. Cases of unexpected deliveries at birth centers or level I maternity hospitals need to be attended emergently. We compared the differences in short- and long-term outcomes between outborn and inborn infants to improve our regional perinatal system. DESIGN Retrospective cohort study. SETTING Neonatal Research Network of Japan database. PATIENTS Extremely preterm infants (gestational age between 22 + 0 and 27 + 6 wk) in the Neonatal Research Network of Japan database between 2003 and 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 12,164 extremely preterm infants, who were divided into outborn (n = 785, 6.5%) and inborn (n = 11,379, 93.5%) groups, were analyzed. Significant differences were observed in demographic and clinical factors between the two groups. Outborn infants had higher short-term odds of severe intraventricular hemorrhage (adjusted odds ratio, 1.49; 95% CI, 1.11-2.00; p < 0.01), necrotizing enterocolitis (adjusted odds ratio, 1.49; 95% CI, 1.11-2.00; p < 0.01), and focal intestinal perforation (adjusted odds ratio, 1.58; 95% CI, 1.09-2.30; p = 0.02). There were no significant differences in long-term outcomes between the two groups, except in the rate of cognitive impairment (adjusted odds ratio, 1.49; 95% CI, 1.01-2.20; p = 0.04). CONCLUSIONS The frequency of severe intraventricular hemorrhage, necrotizing enterocolitis or focal intestinal perforation, and cognitive impairment was significantly higher in outborn infants. Thus, outborn/inborn birth status may play a role in short- and long-term outcomes of extremely preterm infants. However, more data and evaluation of improvement in the current perinatal environment are needed.
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Chen CW, Peng CC, Hsu CH, Chang JH, Lin CY, Jim WT, Sung YH, Lee SC, Chang HY, Lee HC. Value of prenatal diagnosis of meconium peritonitis: Comparison of outcomes of prenatal and postnatal diagnosis. Medicine (Baltimore) 2019; 98:e17079. [PMID: 31574807 PMCID: PMC6775423 DOI: 10.1097/md.0000000000017079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Advancements in diagnostic modalities have improved the diagnosis of meconium peritonitis (MP) both in utero and ex utero. This study aimed to determine the efficacy of prompt prenatal and postnatal diagnoses of MP on the postnatal outcomes of these patients.We conducted a retrospective chart review of neonates with MP admitted to the Mackay Memorial Hospital Systems from 2005 to 2016. The prenatal diagnoses, postnatal presentations, surgical indications, operative methods, types of MP, operative findings, associated anomalies, morbidities, patient outcomes, and survival rates were analyzed. Morbidities included postoperative adhesion ileus, bacteremia, and short bowel syndrome. We also performed subgroup analyses of the morbidity and survival rates of prenatally versus postnatally diagnosed patients, as well as inborn versus outborn neonates.Thirty-seven neonates with MP were enrolled. Of this number, 24 (64.9%) were diagnosed prenatally. Twenty-two (59.5%) were born preterm. The most common prenatal sonographic findings included fetal ascites followed by dilated bowel loops. Abdominal distention was the most frequent postnatal symptom. Thirty-four (91.9%) neonates underwent surgery, whereas 3 were managed conservatively. Volvulus of the gastrointestinal tract was the most frequent anatomic anomaly. The total morbidity and survival rates were 37.8% and 91.9%, respectively. The morbidity and survival rates did not differ significantly between prenatally and postnatally diagnosed patients (37.5% vs 33.3%, P = 1.00; 91.7% vs 92.3%, P = 1.00, respectively). Inborn and outborn patients did not differ in terms of morbidity and survival rates (27.3% vs 53.3%, P = .17; 100% vs 80.0%, P = .06, respectively).Although not statistically significant, inborn MP neonates had higher survival rates when compared with outborn MP neonates. Prompt postnatal management at tertiary centers seemed crucial.
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Affiliation(s)
- Cheng-Wei Chen
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Chun-Chih Peng
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Chyong-Hsin Hsu
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Jui-Hsing Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Chia-Ying Lin
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Wai-Tim Jim
- Department of Pediatrics, Tamsui MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Hsiang Sung
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Szu-Chia Lee
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Hung-Yang Chang
- Department of Neonatology, MacKay Children's Hospital, Taipei
| | - Hung-Chang Lee
- Department of Neonatology, MacKay Children's Hospital, Taipei
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Amer R, Moddemann D, Seshia M, Alvaro R, Synnes A, Lee KS, Lee SK, Shah PS, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Aziz K, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Mukerji A, Da O, Nwaesei C, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Faucher D, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Deshpandey A, Afifi J, Kajetanowicz A, Pillay T, Sauvé R, Hendson L, Reichert A, Bodani J, Sankaran K, deCabo C, Nwaesei C, Daboval T, Dow K, Lee D, Ly L, Kelly E, el Helou S, Church P, Pelausa E, Beltempo M, Levebrve F, Demers C, Bélanger S, Canning R, Monterrosa L, Makary H, Vincer M, Murphy P. Neurodevelopmental Outcomes of Infants Born at <29 Weeks of Gestation Admitted to Canadian Neonatal Intensive Care Units Based on Location of Birth. J Pediatr 2018; 196:31-37.e1. [PMID: 29305231 DOI: 10.1016/j.jpeds.2017.11.038] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 07/27/2017] [Revised: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs). STUDY DESIGN Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity. RESULTS Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values <.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P < .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P < .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3). CONCLUSIONS The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates.
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Affiliation(s)
- Reem Amer
- Department of Pediatrics, University of Manitoba, Canada
| | | | - Mary Seshia
- Department of Pediatrics, University of Manitoba, Canada
| | - Ruben Alvaro
- Department of Pediatrics, University of Manitoba, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyong-Soon Lee
- Department of Pediatrics, Sickkids Hospital, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Thompson K, Gardiner J, Resnick S. Outcome of outborn infants at the borderline of viability in Western Australia: A retrospective cohort study. J Paediatr Child Health 2016; 52:728-33. [PMID: 27149045 DOI: 10.1111/jpc.13187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 01/08/2023]
Abstract
AIM Preterm infants have a high risk of morbidity and mortality, which increases with decreasing gestational age. Inborn infants (infants born in tertiary perinatal centres) have higher survival and lower morbidity than outborn infants. We aimed to compare short-term and 1-year developmental outcomes of outborn infants at the borderline of viability (≥23 to ≤25 + 6 weeks gestation) with a similar cohort of inborn infants in the sole tertiary perinatal centre in Western Australia from 2001 to 2011. METHODS This was a retrospective cohort study. Outborn infants ≥23 to ≤25 + 6 weeks gestation who survived to be transported to the Neonatal Intensive Care Unit (NICU) in the perinatal centre were contemporaneously matched to the next inborn infant of comparable gestation and birth weight. We compared mortality, morbidity (including intraventricular haemorrhage, necrotising enterocolitis and chronic lung disease) and Griffiths General Quotient scores at 1-year corrected age. RESULTS There were 54 outborn and 519 inborn births in the gestational age range during the study period. Thirty-five (65%) outborn infants were transported to the NICU. Of the outborn infants, 21/54 (39%) survived to discharge compared with 375/519 (72%) inborn infants. For the 35 outborn infants transported to NICU, 14 (40%) died, compared with 6/35 (17%) of inborn infants. There were no differences in short-term and developmental outcomes in surviving infants. CONCLUSIONS Outborn extremely preterm infants <26 weeks gestation have higher mortality than inborn counterparts. However, those transported to a tertiary NICU have similar morbidity and developmental outcomes.
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Affiliation(s)
- Kirsten Thompson
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - Jacqueline Gardiner
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Steven Resnick
- Neonatology Clinical Care Unit, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Princess Margaret Hospital, Subiaco, Western Australia, Australia
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Mahoney K, Bajuk B, Oei J, Lui K, Abdel-Latif ME. Risk of neurodevelopmental impairment for outborn extremely preterm infants in an Australian regional network. J Matern Fetal Neonatal Med 2016; 30:96-102. [PMID: 26957041 DOI: 10.3109/14767058.2016.1163675] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/13/2022]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes at 2-3 years in extremely premature outborn and inborn infants. DESIGN Population-based retrospective cohort study. SETTING Geographically defined area of New South Wales (NSW) and the Australian Capital Territory (ACT) served by a network of 10 neonatal intensive care units (NICUs). PATIENTS All premature infants <29 weeks gestation born between 1998 and 2004 in the setting. INTERVENTION At 2-3 years, corrected age, 1473 children were assessed with either the Griffiths Mental Developmental Scales (GMDS) or the Bayley Scales of Infant Development (BSID-II). MAIN OUTCOME MEASURE Moderate/severe functional disability (FD) defined as: developmental delay (GMDS general quotient (GQ) or BSID-II mental developmental index (MDI)) > 2 standard deviations (SD) below the mean; cerebral palsy (CP) requiring aids; sensorineural or conductive deafness (requiring amplification); or bilateral blindness (visual acuity <6/60 in better eye). RESULTS At 2-3 years, moderate/severe functional disability does not appear to be significantly different between outborn and inborn infants (adjusted OR 0.782; 95% CI 0.424-1.443). However, there were a significant number of outborn infants lost to follow up (23.3% versus 42.9%). CONCLUSION In this cohort, at 2-3 years follow up neurodevelopmental outcome does not appear to be significantly different between outborn and inborn infants. These results should be interpreted with caution given the limitation of this study.
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Affiliation(s)
- Kate Mahoney
- a Medical School, College of Medicine, Biology & Environment, Australian National University , Acton, Canberra, Australian Capital Territory , Australia
| | - Barbara Bajuk
- b Neonatal Intensive Care Units' (NICUS) Data Collection, NSW Pregnancy and Newborn Services Network (PSN), Sydney Children's Hospitals Network , NSW , Australia
| | - Julee Oei
- c Department of Newborn Care , Royal Hospital for Women , NSW , Australia.,d School of Women's and Children's Heath, University of New South Wales , NSW , Australia , and
| | - Kei Lui
- c Department of Newborn Care , Royal Hospital for Women , NSW , Australia.,d School of Women's and Children's Heath, University of New South Wales , NSW , Australia , and
| | - Mohamed E Abdel-Latif
- a Medical School, College of Medicine, Biology & Environment, Australian National University , Acton, Canberra, Australian Capital Territory , Australia.,e Department of Neonatology , Centenary Hospital for Women and Children , Garran, Australian Capital Territory , Australia
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