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Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, Bujold E. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44-54. [PMID: 38096892 DOI: 10.1016/s0140-6736(23)01855-x] [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: 05/18/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery. METHODS We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559. FINDINGS 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups. INTERPRETATION A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture. FUNDING Canadian Institutes of Health Research (CIHR, MOP-142448).
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Affiliation(s)
- Nils Chaillet
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada.
| | - Benoît Mâsse
- School of Public Health, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Gauthier
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Patrick Rozenberg
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Marylène Dugas
- Department of Health Sciences, Interdisciplinary Research Chair in Rural Health and Social Services, University of Quebec at Rimouski, Rimouski, QC, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada; CHU Ste-Justine Research Center, Montreal, QC, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Suzanne Demers
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec, QC, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Sherbrooke University, Sherbrooke, QC, Canada
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Guy-Paul Gagné
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Diane Francoeur
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Louise Duperron
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, University of Montreal, QC, Canada
| | - Mira Johri
- School of Public Health, University of Montreal, Montreal, QC, Canada; University of Montreal Hospital Research Center, University of Montreal, QC, Canada
| | - Eric Dubé
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Simon Blouin
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | | | - Mario Girard
- Research Center of the CHU de Québec-Université Laval, Laval University, Quebec, QC, Canada
| | - Emmanuel Bujold
- CHU de Québec Research Center, Department of Obstetrics and Gynecology, Laval University, Quebec, QC, Canada
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Melamed N, Weitzner O, Church P, Banihani R, Barrett J, Yang J, Wong J, Piedboeuf B, Shah PS. Neonatal and Early Childhood Outcomes of Twin and Singleton Infants Born Preterm. J Pediatr 2023; 262:113377. [PMID: 36871787 DOI: 10.1016/j.jpeds.2023.02.021] [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: 08/21/2022] [Revised: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To compare neonatal and early-childhood outcomes of twins and singletons born preterm and explore the association of chorionicity with outcomes. STUDY DESIGN This was a national retrospective cohort study of singleton and twin infants admitted at 230/7-286/7 weeks to level III neonatal intensive care units in Canada (2010-2020). The primary neonatal outcome was a composite of neonatal death or severe neonatal morbidities. The primary early-childhood outcome was a composite of death or significant neurodevelopmental impairment. RESULTS The study cohort included 3554 twin and 12 815 singleton infants. Twin infants born at 230/7-256/7 weeks had a greater risk of the composite neonatal outcome (adjusted risk ratio 1.04, 95% CI 1.01-1.07). However, these differences were limited to the subgroups of same-sex and monochorionic twin pregnancies. Twin infants of 230/7-256/7 weeks were also at an increased risk of the composite early-childhood outcome (adjusted risk ratio 1.22, 95% CI 1.09-1.37). Twin infants of 260/7-286/7 weeks were not at an increased risk of adverse neonatal outcomes or the composite early-childhood outcome compared with singleton infants. CONCLUSIONS Among infants born at 230/7-256/7 weeks, twins have a greater risk of adverse neonatal outcomes and the composite early-childhood outcome than singleton infants. However, the increased risk of adverse neonatal outcomes is mostly limited to monochorionic twins and may thus be driven by complications related to monochorionic placentation.
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Affiliation(s)
- Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
| | - Omer Weitzner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Paige Church
- Department of Newborn & Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rudaina Banihani
- Department of Newborn & Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Junmin Yang
- Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jonathan Wong
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Prakesh S Shah
- Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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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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Chaillet N, Masse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser W, Gagnon R, Monnier P, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Ducruet T, Girard M, Bujold E. A cluster-randomized trial to reduce perinatal morbidity among women with a prior cesarean delivery (PRISMA). Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.005] [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: 01/09/2023]
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Afifi J, Shah PS, Ye XY, Shah V, Piedboeuf B, Barrington K, Kelly E, El-Naggar W. Epidemiology of post-hemorrhagic ventricular dilatation in very preterm infants. J Perinatol 2022; 42:1392-1399. [PMID: 35945347 DOI: 10.1038/s41372-022-01483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the incidence, trends, management's variability and short-term outcomes of preterm infants with severe post-hemorrhagic ventricular dilatation (sPHVD). METHODS We reviewed infants <33 weeks' gestation who had PHVD and were admitted to the Canadian Neonatal Network between 2010 and 2018. We compared perinatal characteristics and short-term outcomes between those with sPHVD and those with mild/moderate PHVD and those with and without ventriculo-peritoneal (VP) shunt. RESULTS Of 29,417 infants, 2439 (8%) had PHVD; rate increased from 7.3% in 2010 to 9.6% in 2018 (P = 0.005). Among infants with PHVD, sPHVD (19%) and VP shunt (29%) rates varied significantly across Canadian centers and between geographic regions (P < 0.01 and P = 0.0002). On multivariable analysis, sPHVD was associated with greater mortality, seizures and meningitis compared to mild/moderate PHVD. CONCLUSIONS Significant variability in sPHVD and VP shunt rates exists between centers and regions in Canada. sPHVD was associated with increased mortality and morbidities.
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Affiliation(s)
- Jehier Afifi
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NS, Canada.
| | - Prakesh S Shah
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Xiang Y Ye
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Vibhuti Shah
- Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Keith Barrington
- Department of Pediatrics, CHU Sainte Justine, Québec, QC, Canada
| | - Edmond Kelly
- Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Walid El-Naggar
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
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von Dadelszen P, Audibert F, Bujold E, Bone JN, Sandhu A, Li J, Kariya C, Chung Y, Lee T, Au K, Skoll MA, Vidler M, Magee LA, Piedboeuf B, Baker PN, Lalji S, Lim KI. Halting the Canadian STRIDER randomised controlled trial of sildenafil for severe, early-onset fetal growth restriction: ethical, methodological, and pragmatic considerations. BMC Res Notes 2022; 15:244. [PMID: 35799272 PMCID: PMC9264704 DOI: 10.1186/s13104-022-06107-y] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To determine the efficacy and safety of sildenafil citrate to improve outcomes in pregnancies complicated by early-onset, dismal prognosis, fetal growth restriction (FGR). Eligibility: women ≥ 18 years, singleton, 18 + 0–27 + 6 weeks’ gestation, estimated fetal weight < 700 g, low PLFG, and ≥ 1 of (i) abdominal circumference < 10th percentile for gestational age (GA); or (ii) reduced growth velocity and either abnormal uterine artery Doppler or prior early-onset FGR with adverse outcome. Ineligibility criteria included: planned termination or reversed umbilical artery end-diastolic flow. Eligibility confirmed by placental growth factor (PlGF) < 5 th percentile for GA measured post randomization. Women randomly received (1:1) either sildenafil 25 mg three times daily or matched placebo until either delivery or 31 + 6 weeks. Primary outcome: delivery GA. The trial stopped early when Dutch STRIDER signalled potential harm; despite distinct eligibility criteria and IRB and DSMB support to continue, because of futility. NCT02442492 [registered 13/05/2015]. Results Between May 2017 and June 2018, 21 (90 planned) women were randomised [10 sildenafil; 11 placebo (1 withdrawal)]. Baseline characteristics, PlGF levels, maternal and perinatal outcomes, and adverse events did not differ. Delivery GA: 26 + 6 weeks (sildenafil) vs 29 + 2 weeks (placebo); p = 0.200. Data will contribute to an individual participant data meta-analysis.
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Affiliation(s)
- Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK. .,Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - François Audibert
- Département d'Obstétrique-Gynécologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Emmanuel Bujold
- Département d'Obstétrique, de Gynécologie et de Reproduction, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ash Sandhu
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Chirag Kariya
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Youkee Chung
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Tang Lee
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Kelvin Au
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - M Amanda Skoll
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Bruno Piedboeuf
- Département de Pédiatrie, Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Philip N Baker
- Pro-Vice-Chancellor Research and Enterprise, University of Leicester, Leicester, UK
| | - Sayrin Lalji
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth I Lim
- Department of Obstetrics and Gynaecology, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Guillot M, Synnes A, Pronovost E, Qureshi M, Daboval T, Caouette G, Olivier F, Bartholomew J, Mohamed I, Massé E, Afifi J, Hendson L, Lemyre B, Luu TM, Strueby L, Cieslak Z, Yusuf K, Pelligra G, Ducruet T, Ndiaye ABKT, Angoa G, Sériès T, Piedboeuf B, Nuyt AM, Fraser W, Mâsse B, Lacaze-Masmonteil T, Lavoie PM, Marc I. Maternal High-Dose DHA Supplementation and Neurodevelopment at 18-22 Months of Preterm Children. Pediatrics 2022; 150:188230. [PMID: 35652296 DOI: 10.1542/peds.2021-055819] [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] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months' corrected age (CA). METHODS Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks' gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks' postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months' CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks' gestation) and sex. RESULTS Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months' CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were -0.07 (95% confidence interval [CI] -3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI -1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI -2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks' gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08-10.03, P = .05). There was no interaction between treatment group and sex. CONCLUSIONS Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months' CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks' GA.
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Affiliation(s)
- Mireille Guillot
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Anne Synnes
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Etienne Pronovost
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Thierry Daboval
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Georges Caouette
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | | | - Julie Bartholomew
- Department of Neonatology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Quebec, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Novia Scotia, Canada
| | - Leonora Hendson
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Zenon Cieslak
- Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Gustavo Pelligra
- Department of Maternity Care & Pediatrics, Victoria General Hospital, Island Health, Victoria, British Columbia, Canada
| | - Thierry Ducruet
- Unité de Recherche Clinique Appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | | | - Georgina Angoa
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Bruno Piedboeuf
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada.,School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Pascal M Lavoie
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Isabelle Marc
- Faculty of Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Quebec, Canada
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Ndiaye AB, Mohamed I, Pronovost E, Angoa G, Piedboeuf B, Lemyre B, Afifi J, Qureshi M, Sériès T, Guillot M, Simonyan D, Yusuf K, Lavoie PM, Fraser WD, Mâsse B, Nuyt AM, Lacaze‐Masmonteil T, Marc I. Use of SMOF Lipid Emulsion in Very Preterm Infants Does Not Affect the Incidence of Bronchopulmonary Dysplasia‐Free Survival. JPEN J Parenter Enteral Nutr 2022; 46:1892-1902. [DOI: 10.1002/jpen.2380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022]
Affiliation(s)
| | - Ibrahim Mohamed
- Department of Pediatrics Université de Montréal, CHU Sainte‐Justine Montréal Canada
| | - Etienne Pronovost
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - Georgina Angoa
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - Bruno Piedboeuf
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - Brigitte Lemyre
- Division of Neonatology Children's Hospital of Eastern Ontario Ottawa Canada
| | - Jehier Afifi
- Department of Pediatrics Dalhousie University Halifax Canada
| | - Mosarrat Qureshi
- Division of Neonatology Royal Alexandra Hospital Edmonton Canada
| | - Thibaut Sériès
- School of Psychology Université du Québec à Trois‐Rivières, Trois‐Rivières Canada
| | - Mireille Guillot
- Department of Pediatrics CHU de Québec‐Université Laval Québec Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre de recherche du CHU de Québec‐Université Laval Québec Canada
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine University of Calgary Calgary Canada
| | - Pascal M. Lavoie
- Department of Pediatrics University of British Columbia Vancouver Canada
| | - William D. Fraser
- Department of Obstetrics and Gynecology Centre de recherche du CHU de Sherbrooke Sherbrooke Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, CHU Sainte‐Justine Montréal Canada
- School of Public Health Université de Montréal, Montréal Canada
| | - Anne Monique Nuyt
- Department of Pediatrics Université de Montréal, CHU Sainte‐Justine Montréal Canada
| | - Thierry Lacaze‐Masmonteil
- Department of Pediatrics, Cumming School of Medicine, Foothills Medical Centre University of Calgary Calgary Canada
| | - Isabelle Marc
- Department of Pediatrics CHU de Québec‐Université Laval Québec 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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10
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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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11
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Angoa G, Pronovost E, Ndiaye ABKT, Lavoie PM, Lemyre B, Mohamed I, Simonyan D, Qureshi M, Afifi J, Yusuf K, Sériès T, Guillot M, Piedboeuf B, Fraser WD, Nuyt AM, Mâsse B, Lacaze-Masmonteil T, Marc I. Effect of Maternal Docosahexaenoic Acid Supplementation on Very Preterm Infant Growth: Secondary Outcome of a Randomized Clinical Trial. Neonatology 2022; 119:377-385. [PMID: 35413719 DOI: 10.1159/000524147] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The aim of the study was to determine the effect of a maternal docosahexaenoic acid (DHA) supplementation during lactation, compared with a placebo, on the neonatal growth profile of breastfed very preterm infants. METHODS Preterm infants' growth profile, growth velocity from birth to 36 weeks' postmenstrual age (PMA), and growth at 36 weeks' PMA were pre-specified secondary outcomes of a randomized placebo-controlled trial conducted in 16 Canadian neonatal intensive care units (2015-2018). Lactating mothers who delivered before 29 weeks' gestation were given 1.2 g of DHA daily or a placebo within 72 h of delivery and up to 36 weeks' PMA. Analyses were performed using a linear regression model with generalized estimating equations. RESULTS 461 mothers and their 528 infants (DHA, N = 273; placebo, N = 255) were included with mean gestational age of 26.5 weeks (standard deviation [SD] = 1.6); 275 (52.1%) were males; mean birth weight was 895 g (SD = 240). DHA interaction with sex was significant on weight profile (interaction p < 0.001), weight velocity (interaction p = 0.05), and weight at 36 weeks' PMA (interaction p = 0.02). Females in the DHA group gained more weight compared to the placebo group (mean difference [MD], 52.6 g [95% confidence interval [CI]: 24.5-80.8], p < 0.001). Weight velocity was significantly higher in females of the DHA group (MD, 3.4 g/kg/day [95% CI: 0.6-6.2], p = 0.02). At 36 weeks' PMA, the weight of males in the DHA group was significantly smaller (MD, -88.9 g [95% CI: -166.2 to -11.6], p = 0.02). CONCLUSION DHA positively affected female infants' neonatal weight profile and velocity and negatively affected male infants' weight at 36 weeks' PMA.
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Affiliation(s)
- Georgina Angoa
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | | | - Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brigitte Lemyre
- Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Mireille Guillot
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - William Donald Fraser
- Department of Obstetrics and Gynecology, Centre de recherche du CHU de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Monique Nuyt
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Benoît Mâsse
- Unité de Recherche Clinique Appliquée, CHU Sainte-Justine, Montréal, Québec, Canada.,School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Isabelle Marc
- Department of Pediatrics, Faculty of Medicine, CHU de Québec-Université Laval, Québec, Québec, Canada
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12
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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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13
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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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14
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Soucy-Giguère L, Drolet C, Piedboeuf B, Hébert A. 31 Noninvasive high-frequency oscillatory ventilation in preterm infants: Safe and effective. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.025] [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: 11/15/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Mechanical ventilation is frequently used in preterm infants for various indications, but is associated with multiple complications, including bronchopulmonary dysplasia and poorer neurodevelopmental outcomes. Noninvasive high-frequency oscillatory ventilation (nHFOV) is a noninvasive ventilation (NIV) strategy used to avoid mechanical ventilation and associated complications. However, its effectiveness remains controversial, and its safety has not been established.
Objectives
The objectives were to evaluate the effectiveness of nHFOV to prevent intubations and support adequate ventilation in preterm infants, and to assess its safety profile.
Design/Methods
This was a retrospective crossover case study including 24 infants and 30 nHFOV instances between May 2018 and June 2020. Infants were included if they were placed on nHFOV for at least one hour; each nHFOV trial contributed as one instance. Data was collected from health records. Effectiveness outcomes were: successful transition to another NIV mode without requiring intubation, and variations in CO2, FiO2, and number of spells. Safety outcomes were: apparition of intraventricular hemorrhage (IVH), gastrointestinal complications, nasal cutaneous trauma, and comfort as assessed with the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Descriptive statistics were used for baseline characteristics. Nonparametric and semiparametric tests were used to compare outcomes pre- and during nHFOV.
Results
Baseline characteristics are presented in Table 1. At initiation of nHFOV, mean chronological age and weight were 24 days (95% CI: 20 – 28) and 1119 grams (95% CI: 1038 – 1200) respectively. The most frequent indication for nHFOV was spells (56.7%), and the mean duration of nHFOV instances was 3.9 days (95% CI: 2.7 – 5.1) (Table 1). In 18 (60%) cases, infants transitioned successfully to another NIV mode without requiring intubation. Levels of CO2 and number of spells were significantly lower during nHFOV than pre-nHFOV. There was no significant difference in FiO2 pre-nHFOV and during nHFOV. No apparition or progression of IVH was observed following the use of nHFOV. There was no significant difference in N-PASS, nasal trauma, and gastrointestinal complications pre-nHFOV and during nHFOV (Table 2).
Conclusion
This study suggests that nHFOV is an effective ventilation method to avoid intubation and to decrease spells in preterm infants, without increasing complications.
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15
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Roychoudhury S, Lodha A, Synnes A, Abou Mehrem A, Canning R, Banihani R, Beltempo M, Theriault K, Yang J, Shah PS, Soraisham AS, Ting J, Abou Mehrem A, Alvaro R, Adie M, Ng E, Pelausa E, Beltempo M, Claveau M, Barrington K, Lapoint A, Ethier G, Drolet C, Piedboeuf B, Afifi J, Dahlgren L, Wood S, Metcalfe A, O’Quinn C, Helewa M, Taboun F, Melamed N, Abenhaim H, Wou K, Gratton R, Boucoiran I, Taillefer C, Theriault K, Allen V, Synnes A, Grunau R, Hendson L, Moddemann D, de Cabo C, Nwaesei C, Church P, Banihani R, Pelausa E, Nguyen KA, Khairy M, Beltempo M, Dorval V, Luu TM, Bélanger S, Afifi J. Neurodevelopmental outcomes of preterm infants conceived by assisted reproductive technology. Am J Obstet Gynecol 2021; 225:276.e1-276.e9. [PMID: 33798481 DOI: 10.1016/j.ajog.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There have been concerns about the development of children conceived through assisted reproductive technology. Despite multiple studies investigating the outcomes of assisted conception, data focusing specifically on the neurodevelopmental outcomes of infants conceived through assisted reproductive technology and born preterm are limited. OBJECTIVE This study aimed to evaluate and compare the neurodevelopmental outcomes of preterm infants born at <29 weeks' gestation at 18 to 24 months' corrected age who were conceived through assisted reproductive technology and those who were conceived naturally. STUDY DESIGN This retrospective cohort study included inborn, nonanomalous infants, born at <29 weeks' gestation between January 1, 2010, and December 31, 2016, who had a neurodevelopmental assessment at 18 to 24 months' corrected age at any of the 10 Canadian Neonatal Follow-Up Network clinics. The primary outcome was neurodevelopmental impairment at 18 to 24 months, defined as the presence of any of the following: cerebral palsy; Bayley-III cognitive, motor, or language composite score of <85; sensorineural or mixed hearing loss; and unilateral or bilateral visual impairment. Secondary outcomes included mortality, composite of mortality or neurodevelopmental impairment, significant neurodevelopmental impairment, and each component of the primary outcome. We compared outcomes between infants conceived through assisted reproductive technology and those conceived naturally, using bivariate and multivariable analyses after adjustment. RESULTS Of the 4863 eligible neonates, 651 (13.4%) were conceived using assisted reproductive technology. Maternal age; education level; and rates of diabetes mellitus, receipt of antenatal corticosteroids, and cesarean delivery were higher in the assisted reproduction group than the natural conception group. Neonatal morbidity and death rates were similar except for intraventricular hemorrhage, which was lower in the assisted reproduction group (33% [181 of 546] vs 39% [1284 of 3318]; P=.01). Of the 4176 surviving infants, 3386 (81%) had a follow-up outcome at 18 to 24 months' corrected age. Multivariable logistic regression adjusting for gestational age, antenatal steroids, sex, small for gestational age, multiple gestations, mode of delivery, maternal age, maternal education, pregnancy-induced hypertension, maternal diabetes mellitus, and smoking showed that infants conceived through assisted reproduction was associated with lower odds of neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86) and the composite of death or neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.54-0.84). Conception through assisted reproductive technology was associated with decreased odds of a Bayley-III composite cognitive score of <85 (adjusted odds ratio, 0.68; 95% confidence interval, 0.48-0.99) and composite language score of <85 (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.88). CONCLUSION Compared with natural conception, assisted conception was associated with lower odds of adverse neurodevelopmental outcomes, especially cognitive and language outcomes, at 18 to 24 months' corrected age among preterm infants born at <29 weeks' gestation. Long-term follow-up studies are required to assess the risks of learning disabilities and development of complex visual-spatial and processing skills in these children as they reach school age.
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Qureshi M, Shah PS, Abdelgadir D, Ye XY, Afifi J, Yuen R, Crossman SC, Taylor B, Mohammad K, Piedboeuf B, Aziz K. Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury. J Pediatr 2021; 235:26-33.e2. [PMID: 33689709 DOI: 10.1016/j.jpeds.2021.02.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/17/2020] [Revised: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the impact of prophylactic indomethacin on early death (<10 days after birth) or severe neurologic injury and on early death or spontaneous intestinal perforation by completed weeks of gestational age in neonates born <29 weeks of gestation. STUDY DESIGN This was a multicenter, retrospective cohort study of neonates (n = 12 515) born at 236/7 weeks of gestational age, admitted to neonatal intensive care units participating in the Canadian Neonatal Network who received prophylactic indomethacin started within the first 12 hours after birth. Univariate and multivariate analysis compared the composite outcomes of early death or severe neurologic injury and early death or spontaneous intestinal perforation. RESULTS Of 12 515 eligible neonates, 1435 (11.5%) were exposed to prophylactic indomethacin; recipients were of lower gestational age and birth weight and had greater severity of illness (Score of Neonatal Acute Physiology with Perinatal Extension) on admission compared with nonrecipients. After we adjusted for confounders, prophylactic indomethacin was associated with reduced odds of early death or severe neurologic injury and early death or spontaneous intestinal perforation in neonates born at 23-24 weeks of gestational age. However, prophylactic indomethacin was associated with increased odds of early mortality or spontaneous intestinal perforation for neonates born at 26-28 weeks of gestational age. CONCLUSIONS Prophylactic indomethacin use was associated with benefit in neonates born at 23-24 weeks of gestational age, but with harm at 26-28 weeks of gestational age. Given the observation of significantly improved survival, a randomized controlled trial is needed to investigate the effect of prophylactic indomethacin in babies born at 23-25 weeks of gestational age.
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Affiliation(s)
- Mosarrat Qureshi
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dalal Abdelgadir
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Xiang Y Ye
- MiCare Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Yuen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | - Barbara Taylor
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Laval University, Quebec City, Quebec, Canada
| | - Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Mohammad K, Scott JN, Leijser LM, Zein H, Afifi J, Piedboeuf B, de Vries LS, van Wezel-Meijler G, Lee SK, Shah PS. Consensus Approach for Standardizing the Screening and Classification of Preterm Brain Injury Diagnosed With Cranial Ultrasound: A Canadian Perspective. Front Pediatr 2021; 9:618236. [PMID: 33763394 PMCID: PMC7982529 DOI: 10.3389/fped.2021.618236] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 12/16/2022] Open
Abstract
Acquired brain injury remains common in very preterm infants and is associated with significant risks for short- and long-term morbidities. Cranial ultrasound has been widely adopted as the first-line neuroimaging modality to study the neonatal brain. It can reliably detect clinically significant abnormalities that include germinal matrix and intraventricular hemorrhage, periventricular hemorrhagic infarction, post-hemorrhagic ventricular dilatation, cerebellar hemorrhage, and white matter injury. The purpose of this article is to provide a consensus approach for detecting and classifying preterm brain injury to reduce variability in diagnosis and classification between neonatologists and radiologists. Our overarching goal with this work was to achieve homogeneity between different neonatal intensive care units across a large country (Canada) with regards to classification, timing of brain injury screening and frequency of follow up imaging. We propose an algorithmic approach that can help stratify different grades of germinal matrix-intraventricular hemorrhage, white matter injury, and ventricular dilatation in very preterm infants.
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Affiliation(s)
- Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - James N Scott
- Departments of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Lara M Leijser
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Hussein Zein
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Université Laval and Centre de recherche du CHU de Québec - Université Laval, Quebec City, QC, Canada
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Brain Center, University Utrecht, Utrecht, Netherlands
| | | | - Shoo K Lee
- Department of Pediatrics, Mount Sinai hospital, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai hospital, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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18
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Marc I, Piedboeuf B, Lacaze-Masmonteil T, Fraser W, Mâsse B, Mohamed I, Qureshi M, Afifi J, Lemyre B, Caouette G, Bartholomew J, Nuyt AM, Julien P, Synnes A, Lucas M, Perreault T, Strueby L, Cieslak Z, Yusuf K, Pelligra G, Massé E, Larsen B, de Cabo C, Ruth C, Khurshid F, Lavoie PM. Effect of Maternal Docosahexaenoic Acid Supplementation on Bronchopulmonary Dysplasia-Free Survival in Breastfed Preterm Infants: A Randomized Clinical Trial. JAMA 2020; 324:157-167. [PMID: 32662862 PMCID: PMC7361648 DOI: 10.1001/jama.2020.8896] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Maternal docosahexaenoic acid (DHA) supplementation may prevent bronchopulmonary dysplasia, but evidence remains inconclusive. OBJECTIVE To determine whether maternal DHA supplementation during the neonatal period improves bronchopulmonary dysplasia-free survival in breastfed infants born before 29 weeks of gestation. DESIGN, SETTING, AND PARTICIPANTS Superiority, placebo-controlled randomized clinical trial at 16 Canadian neonatal intensive care units (June 2015-April 2018 with last infant follow-up in July 2018). Lactating women who delivered before 29 weeks of gestation were enrolled within 72 hours of delivery. The trial intended to enroll 800 mothers, but was stopped earlier. INTERVENTIONS There were 232 mothers (273 infants) assigned to oral capsules providing 1.2 g/d of DHA from randomization to 36 weeks' postmenstrual age and 229 mothers (255 infants) assigned to placebo capsules. MAIN OUTCOMES AND MEASURES The primary outcome was bronchopulmonary dysplasia-free survival in infants at 36 weeks' postmenstrual age. There were 22 secondary outcomes, including mortality and bronchopulmonary dysplasia. RESULTS Enrollment was stopped early due to concern for harm based on interim data from this trial and from another trial that was published during the course of this study. Among 461 mothers and their 528 infants (mean gestational age, 26.6 weeks [SD, 1.6 weeks]; 253 [47.9%] females), 375 mothers (81.3%) and 523 infants (99.1%) completed the trial. Overall, 147 of 268 infants (54.9%) in the DHA group vs 157 of 255 infants (61.6%) in the placebo group survived without bronchopulmonary dysplasia (absolute difference, -5.0% [95% CI, -11.6% to 2.6%]; relative risk, 0.91 [95% CI, 0.80 to 1.04], P = .18). Mortality occurred in 6.0% of infants in the DHA group vs 10.2% of infants in the placebo group (absolute difference, -3.9% [95% CI, -6.8% to 1.4%]; relative risk, 0.61 [95% CI, 0.33 to 1.13], P = .12). Bronchopulmonary dysplasia occurred in 41.7% of surviving infants in the DHA group vs 31.4% in the placebo group (absolute difference, 11.5% [95% CI, 2.3% to 23.2%]; relative risk, 1.36 [95% CI, 1.07 to 1.73], P = .01). Of 22 prespecified secondary outcomes, 19 were not significantly different. CONCLUSIONS AND RELEVANCE Among breastfed preterm infants born before 29 weeks of gestation, maternal docosahexaenoic acid supplementation during the neonatal period did not significantly improve bronchopulmonary dysplasia-free survival at 36 weeks' postmenstrual age compared with placebo. Study interpretation is limited by early trial termination. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02371460.
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Affiliation(s)
- Isabelle Marc
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - William Fraser
- Department of Obstetrics and Gynecology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Benoît Mâsse
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ibrahim Mohamed
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Mosarrat Qureshi
- Division of Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jehier Afifi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brigitte Lemyre
- Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Georges Caouette
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Julie Bartholomew
- Department of Neonatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Department of Pediatrics, Université de Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Pierre Julien
- Department of Endocrinology and Nephrology, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Anne Synnes
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Michel Lucas
- Department of Social and Preventive Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Hôpital du Saint-Sacrement, Quebec City, Quebec, Canada
| | - Thérèse Perreault
- Division of Neonatology, Montréal Children’s Hospital, McGill University, Montreal, Quebec, Canada
| | - Lannae Strueby
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Zenon Cieslak
- Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Kamran Yusuf
- Department of Pediatrics, Section of Neonatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gustavo Pelligra
- Department of Maternity Care and Pediatrics, Victoria General Hospital, Island Health, Victoria, British Columbia, Canada
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Quebec, Canada
| | - Bodil Larsen
- Faculty of Agricultural, Life, and Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Cecilia de Cabo
- Department of Pediatrics and Child Health, Max Rady School of Medicine, University of Manitoba, Winnipeg, Canada
| | - Chelsea Ruth
- Department of Pediatrics and Child Health, Max Rady School of Medicine, University of Manitoba, Winnipeg, Canada
| | - Faiza Khurshid
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
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19
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Lee SK, Beltempo M, McMillan DD, Seshia M, Singhal N, Dow K, Aziz K, Piedboeuf B, Shah PS. Outcomes and care practices for preterm infants born at less than 33 weeks' gestation: a quality-improvement study. CMAJ 2020; 192:E81-E91. [PMID: 31988152 DOI: 10.1503/cmaj.190940] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.
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Affiliation(s)
- Shoo K Lee
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Marc Beltempo
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Douglas D McMillan
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Mary Seshia
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Nalini Singhal
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Kimberly Dow
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Khalid Aziz
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Bruno Piedboeuf
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont
| | - Prakesh S Shah
- Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont.
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20
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Lemieux-Bourque C, Piedboeuf B, Fontela PS, Bornais K, Beltempo M. Pressure versus Sudden Wean from Nasal Continuous Positive Airway Pressure in Preterm Infants: A Systematic Review and Meta-Analysis. Neonatology 2020; 117:537-544. [PMID: 32580200 DOI: 10.1159/000507863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 02/11/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nasal continuous positive airway pressure (NCPAP) is a well-studied treatment for respiratory problems in preterm infants. However, the best strategy for NCPAP weaning is unknown. OBJECTIVE We aimed to compare the success of progressive pressure wean versus sudden wean for discontinuation of NCPAP in preterm infants. METHODS We conducted a systematic review and meta-analysis of publications identified by searching MEDLINE, Embase, -CINAHL, and CENTRAL. Randomized controlled trials comparing pressure wean to sudden wean for NCPAP in preterm infants were included. Primary outcomes were postmenstrual age (PMA) at successful weaning and weight gain. Secondary outcomes were total duration of ventilation, success of weaning strategy on first attempt, length of stay (LOS), and bronchopulmonary dysplasia (BPD). RESULTS Two trials (422 infants) were eligible for inclusion. Pressure wean was associated with a higher PMA at weaning (33.9 ± 2.1 vs. 32.1 ± 2.0 weeks, mean difference [MD] 0.88, 95% CI 0.40 to 1.35, low quality evidence). Daily weight gain was only reported in 1 trial. Total duration of ventilation was not reported. Pressure wean was associated with higher probability of successful weaning at first attempt (risk ratio [RR] 1.25, 95% CI 1.03-1.53). However, it was not associated with LOS (MD -2.5 days, 95% CI -7.3 to 2.4) or BPD (RR 0.92, 95% CI 0.52-1.63). CONCLUSION Sudden wean of NCPAP was associated with a lower PMA at successful wean compared to pressure wean but also with a lower rate of successful wean at first attempt, most likely because of the developmental stage at which weaning is possible.
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Affiliation(s)
- Charlotte Lemieux-Bourque
- CHU de Québec Research Center, Quebec, Québec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Bruno Piedboeuf
- CHU de Québec Research Center, Quebec, Québec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Patricia S Fontela
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada.,Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Kevin Bornais
- Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Québec, Canada, .,McGill University Health Centre Research Institute, Montreal, Québec, Canada,
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21
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Filler G, Kovesi T, Bourdon E, Jones SA, Givelichian L, Rockman-Greenberg C, Gilliland J, Williams M, Orrbine E, Piedboeuf B. Correction to: Does specialist physician supply affect pediatric asthma health outcomes? BMC Health Serv Res 2019; 19:896. [PMID: 31775799 PMCID: PMC6880490 DOI: 10.1186/s12913-019-4752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Guido Filler
- Departments of Peediatrics, Children's Hospital at London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada. .,Departments of Medicine, Children's Hospital at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. .,Departments of Pathology & Laboratory Medicine, Children's Hospital at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Erik Bourdon
- The Canadian Institute for Health Information (CIHI), Ottawa, Ontario, Canada
| | - Sarah Ann Jones
- Departments of Peediatrics, Children's Hospital at London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada.,Departments of Surgery, Children's Hospital at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Laurentiu Givelichian
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jason Gilliland
- Departments of Peediatrics, Children's Hospital at London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada.,Department of Geography, University of Western Ontario, London, Ontario, Canada
| | | | - Elaine Orrbine
- Paediatric Chairs of Canada (PCC), Ottawa, Ontario, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, University Laval, Faculty of Medicine, Quebec City, Quebec, Canada
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22
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Zhong YJ, Claveau M, Yoon EW, Aziz K, Singhal N, Shah PS, Wintermark P, Shah PS, Kanungo J, Ting J, Cieslak Z, Sherlock R, Yee W, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Beltempo M, Bertelle V, Canning R, Makary H, Ojah C, Monterrosa L, Emberley J, Afifi J, Kajetanowicz A, Lee SK. Neonates with a 10-min Apgar score of zero: Outcomes by gestational age. Resuscitation 2019; 143:77-84. [DOI: 10.1016/j.resuscitation.2019.07.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 11/28/2022]
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Berger-Caron F, Piedboeuf B, Morissette G, Simonyan D, Chétaille P, Pellerin A, Hébert A. Inhaled Epoprostenol for Pulmonary Hypertension Treatment in Neonates: A 12-Year Experience. Am J Perinatol 2019; 36:1142-1149. [PMID: 30551229 DOI: 10.1055/s-0038-1676483] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Persistent pulmonary hypertension of the newborn (PPHN) occurs in 10% of neonatal respiratory insufficiency. To selectively reduce pulmonary vascular resistance, several treatments have been tried. Inhaled epoprostenol (iPGI2) has been used for 12 years in our institution for the management of refractory PPHN despite the gaps in the literature to support this use. OBJECTIVES The primary objective was to evaluate the efficacy of iPGI2 for PPHN. The secondary objectives were to describe its use in neonates and assess side effects. STUDY DESIGN This retrospective cohort study included infants < 28 days with PPHN treated with iPGI2 in the neonatal or pediatric intensive care units of our institution between 2004 and 2016. RESULTS We reviewed 43 patient' care episodes (mean gestational age of 36 weeks). This was an extremely ill population with 54% mortality rate. Oxygenation index improved significantly after 12-hour treatment (p = 0.047), with a rebound effect when discontinuing nebulization. By the end of the therapy, the fraction of inspired oxygen had significantly dropped (p = 0.0018). Echocardiographic markers tended to normalize during treatment. No potential side effects were reported. CONCLUSION In these sick newborns, we observed an improvement in PPHN under iPGI2 without significant adverse effects. To our knowledge, this is the largest neonatal cohort reported to have received iPGI2 for PPHN.
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Affiliation(s)
| | - Bruno Piedboeuf
- Division of Neonatology, Department of Paediatrics, CHU de Québec, Université Laval, Québec City, Québec, Canada
| | - Geneviève Morissette
- Division of Pediatric Intensive Care, Department of Paediatrics, CHU de Québec, Université Laval, Québec City, Québec, Canada
| | - David Simonyan
- Department of Biostatistic, Centre de recherche du CHUQ, Université Laval, Québec City, Québec, Canada
| | - Philippe Chétaille
- Division of Pediatric Cardiology, Department of Paediatrics, CHU de Québec, Québec City, Québec, Canada
| | - Annie Pellerin
- Department of Pharmacy, CHU de Québec, Université Laval, Québec City, Québec, Canada
| | - Audrey Hébert
- Division of Neonatology, Department of Paediatrics, CHU de Québec, Université Laval, Québec City, Québec, Canada
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Puligandla P, Skarsgard E, Offringa M, Adatia I, Baird R, Bailey M, Brindle M, Chiu P, Cogswell A, Dakshinamurti S, Flageole H, Keijzer R, McMillan D, Oluyomi-Obi T, Pennaforte T, Perreault T, Piedboeuf B, Riley SP, Ryan G, Synnes A, Traynor M. Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline. CMAJ 2019; 190:E103-E112. [PMID: 29378870 DOI: 10.1503/cmaj.170206] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
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- Montreal Children’s Hospital, Montréal, Que
| | | | | | | | - Ian Adatia
- University of Alberta and Glenwood Radiology and Medical Centre, Edmonton, Alta
| | - Robert Baird
- British Columbia Children’s Hospital, Vancouver, BC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anne Synnes
- British Columbia Women’s Hospital & Health Centre, Vancouver, BC
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25
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Fischer N, Soraisham A, Shah PS, Synnes A, Rabi Y, Singhal N, Ting JY, Creighton D, Dewey D, Ballantyne M, Lodha A, Shah PS, Kanungo J, Ting J, Yee W, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Lapoint A, Drolet C, Piedboeuf B, Claveau M, Beltempo M, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Emberley J, Afifi J, Kajetanowicz A, Lee SK, Canadian Neonatal Follow-Up Network (CNFUN) Investigators, Pillay T, Synnes A, Sauvé R, Hendson L, Reichert A, Bodani J, Sankaran K, Moddemann D, Nwaesei C, Daboval T, Dow K, Lee D, Coughlin K, Ly L, Kelly E, Saigal S, Church P, Pelausa E, Riley P, Luu TM, Lefebvre F, Demers C, Bélanger S, Canning R, Monterrosa L, Makary H, Afifi J, Vincer M, Murphy P. Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes. Resuscitation 2019; 135:57-65. [DOI: 10.1016/j.resuscitation.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/28/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022]
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26
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Parent S, Samson N, Shen J, Gutman G, Bouchard S, Piedboeuf B, Praud JP. A new ovine model of spine and chest wall deformity at birth with alteration of respiratory system mechanics and lung development: a feasibility study. Eur Spine J 2018; 28:114-120. [PMID: 30498959 DOI: 10.1007/s00586-018-5818-3] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop an animal model of spine and chest wall deformity (CWD) at birth and to evaluate its effects on respiratory system mechanics and lung development. METHODS A spine and CWD was created in utero between 70 and 75 days of gestation in six ovine fetuses by resection of the seventh and eighth left ribs. Two days after birth, respiratory system mechanics was assessed in anesthetized lambs using the flexiVent apparatus, followed by postmortem measurement of lung mechanics as well as histological lung analysis. RESULTS A range of severity of CWD was found (Cobb angle from 0° to 48°) with a mean decrease in compliance of 47% and in inspiratory capacity of 39% compared to control lambs. Proof-of-concept histological analysis in one lamb showed marked lung hypoplasia. CONCLUSION Our ovine model represents a pilot proof-of-concept study evaluating the impact of a spine and CWD present at birth on lung respiratory mechanics and development. This study lays down the groundwork for future studies evaluating the impact of these deformities on lung development and potential treatments. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Stefan Parent
- Department of Surgery, Centre de recherche du CHU Sainte-Justine, 3175 Côte-Sainte Catherine, Montreal, H3T 1C5, QC, Canada. .,University of Montreal, Montreal, QC, Canada.
| | - Nathalie Samson
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jesse Shen
- Department of Surgery, Centre de recherche du CHU Sainte-Justine, 3175 Côte-Sainte Catherine, Montreal, H3T 1C5, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Gabriel Gutman
- Department of Surgery, Centre de recherche du CHU Sainte-Justine, 3175 Côte-Sainte Catherine, Montreal, H3T 1C5, QC, Canada.,University of Montreal, Montreal, QC, Canada
| | - Sarah Bouchard
- Department of Surgery, Centre de recherche du CHU Sainte-Justine, 3175 Côte-Sainte Catherine, Montreal, H3T 1C5, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
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27
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Shah PS, Dunn M, Aziz K, Shah V, Deshpandey A, Mukerji A, Ng E, Mohammad K, Ulrich C, Amaral N, Lemyre B, Synnes A, Piedboeuf B, Yee WH, Ye XY, Lee SK. Sustained quality improvement in outcomes of preterm neonates with a gestational age less than 29 weeks: results from the Evidence-based Practice for Improving Quality Phase 3 1. Can J Physiol Pharmacol 2018; 97:213-221. [PMID: 30273497 DOI: 10.1139/cjpp-2018-0439] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 11/22/2022]
Abstract
Quality improvement initiatives in neonatology have yielded positive results; however, few programs have demonstrated sustainability. We evaluated an ongoing, national quality improvement initiative (Evidence-based Practice for Improving Quality Phase 3 (EPIQ-3)) on outcomes of preterm neonates with a gestational age (GA) of 220-286 weeks (i.e., from 22 weeks and 0 days of gestation to 28 weeks and 6 days of gestation). Data from 7459 neonates admitted to 25 Canadian centers between 2013 and 2017 were studied. Trends in mortality and major morbidities were evaluated. The number of neonates with a GA of 220-236 weeks increased from 90 in 2013 to 139 in 2017 without a significant change in any other GA categories. In the entire cohort, the odds of composite outcome of mortality or any major morbidity (adjusted odds ratio (AOR) 0.72, 95% confidence interval (CI) 0.61-0.84) and of necrotizing enterocolitis (AOR 0.66, 95% CI 0.49-0.89) were lower in 2017 than in 2013. When calculated per year, the odds of composite outcome (AOR 0.93, 95% CI 0.89-0.97) and odds of necrotizing enterocolitis (AOR 0.89, 95% CI 0.82-0.96) decreased significantly. Among the subgroup of neonates with a GA of 260-286 weeks, the odds of composite outcome (AOR 0.63, 95% CI 0.51-0.79), necrotizing enterocolitis (AOR 0.44, 95% CI 0.26-0.73), and nosocomial infection (AOR 0.64, 95% CI 0.49-0.84) were reduced. The collaborative, multidisciplinary, nationwide EPIQ-3 program improved outcomes of preterm neonates, and the improvement was sustainable over 5 years.
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Affiliation(s)
- Prakesh S Shah
- a Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.,b Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada.,c Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Michael Dunn
- b Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada.,d Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Khalid Aziz
- e Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Vibhuti Shah
- a Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.,b Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada.,c Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Akhil Deshpandey
- f Division of Newborn Medicine, Department of Pediatrics, Memorial University of Newfoundland and Labrador, St. John's, NL A1B 3V6, Canada
| | - Amit Mukerji
- g Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Eugene Ng
- b Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada.,d Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Khorshid Mohammad
- h Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Cindy Ulrich
- i Neonatal Intensive Care Unit, Children's Care Program, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Nely Amaral
- a Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Brigitte Lemyre
- j Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada.,k Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada.,l Department of Pediatrics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Anne Synnes
- m Division of Neonatology, British Columbia's Women's Hospital, Vancouver, BC V6H 3N1, Canada; Department of Paediatrics, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Bruno Piedboeuf
- n Department of Pediatrics, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Wendy H Yee
- o Department of Pediatrics, Foothills Medical Centre, Alberta Health Services, Calgary, AB T2N 2T9, Canada
| | - Xiang Y Ye
- c Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Shoo K Lee
- a Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.,b Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada.,c Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.,p Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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28
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Bairam A, Laflamme N, Drolet C, Piedboeuf B, Shah PS, Kinkead R. Sex-based differences in apnoea of prematurity: A retrospective cohort study. Exp Physiol 2018; 103:1403-1411. [DOI: 10.1113/ep086996] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Aida Bairam
- Département de Pédiatrie; Université Laval; Québec QC Canada
- Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec; Québec QC Canada
| | - Nathalie Laflamme
- Centre de Recherche du CHU de Québec; Université Laval; Québec QC Canada
| | | | - Bruno Piedboeuf
- Département de Pédiatrie; Université Laval; Québec QC Canada
- Centre de Recherche du CHU de Québec; Université Laval; Québec QC Canada
| | - Prakesh S. Shah
- Department of Pediatrics; University of Toronto; Toronto ON Canada
- Department of Pediatrics; Mount Sinai Hospital; Toronto ON Canada
- Maternal-Infant Care Research Centre; Mount Sinai Hospital; Toronto ON Canada
| | - Richard Kinkead
- Département de Pédiatrie; Université Laval; Québec QC Canada
- Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec; Québec QC Canada
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29
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Beltempo M, Clement K, Lacroix G, Bélanger S, Julien AS, Piedboeuf B. Association of Resident Duty Hour Restrictions, Level of Trainee, and Number of Available Residents with Mortality in the Neonatal Intensive Care Unit. Am J Perinatol 2018. [PMID: 29528467 DOI: 10.1055/s-0038-1627442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU. STUDY DESIGN This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU (N = 185) and infants admitted to the NICU (N = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008-2011 [24-hour shifts] versus 2011-2014 [16-hour shifts]), level of trainee, and the number of residents present at admission. RESULTS The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, p < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33-0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71-2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43-10.02, 5-8 residents vs. 0-2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50-1.07; after vs. before resident duty hour reform). CONCLUSION Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates.
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Affiliation(s)
- Marc Beltempo
- Department of Neonatology, Montreal Children's Hospital, Montréal, Québec, Canada
| | - Karin Clement
- Department of Pediatrics, CHU de Québec, Québec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Quebec, Canada
| | | | | | - Bruno Piedboeuf
- Department of Neonatology, Faculté de Médecine, Université Laval, Quebec, Canada
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Haslam MD, Lisonkova S, Creighton D, Church P, Yang J, Shah PS, Joseph KS, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Fajardo C, Aziz K, Toye J, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Kovacs L, Barrington K, Drolet C, Piedboeuf B, Riley SP, Claveau M, Faucher D, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Andrews W, Deshpandey A, McMillan D, Afifi J, Kajetanowicz A, Lee SK, Pillay T, Sauvé R, Hendson L, Reichert A, Bodani J, Sankaran K, Moddemann D, Nwaesei C, Daboval T, Dow K, Lee D, Ly L, Kelly E, el Helou S, Pelausa E, Riley SP, Lefebvre F, Demers C, Bélanger S, Canning R, Monterrosa L, Makary H, Vincer M, Murphy P. Severe Neurodevelopmental Impairment in Neonates Born Preterm: Impact of Varying Definitions in a Canadian Cohort. J Pediatr 2018; 197:75-81.e4. [PMID: 29398054 DOI: 10.1016/j.jpeds.2017.12.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 07/14/2017] [Revised: 10/18/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. STUDY DESIGN Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included. The incidence of severe NDI, aORs, and 95% CIs were calculated to express the relationship between risk factors and severe NDI using the definitions with the highest and the lowest incidence rates of severe NDI. RESULTS The incidence of severe NDI ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI 3.37-5.47). The associations between risk factors and severe NDI varied depending on the definition used. Maternal ethnicity, employment status, antenatal corticosteroid treatment, and gestational age were not associated consistently with severe NDI. Although maternal substance use, sex, score of neonatal acute physiology >20, late-onset sepsis, bronchopulmonary dysplasia, and brain injury were consistently associated with severe NDI irrespective of definition, the strength of the associations varied. CONCLUSIONS The definition of severe NDI significantly influences the incidence and the associations between risk factors and severe NDI. A standardized definition would facilitate site comparisons and scientific communication.
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Affiliation(s)
- Matthew D Haslam
- School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Sarka Lisonkova
- School of Population and Public Health, University of British Columbia, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Creighton
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Paige Church
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Junmin Yang
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - K S Joseph
- School of Population and Public Health, University of British Columbia, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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31
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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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Filler G, Kovesi T, Bourdon E, Jones SA, Givelichian L, Rockman-Greenberg C, Gilliland J, Williams M, Orrbine E, Piedboeuf B. Does specialist physician supply affect pediatric asthma health outcomes? BMC Health Serv Res 2018; 18:247. [PMID: 29622002 PMCID: PMC5887258 DOI: 10.1186/s12913-018-3084-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Pediatrician and pediatric subspecialist density varies substantially among the various Canadian provinces, as well as among various states in the US. It is unknown whether this variability impacts health outcomes. To study this knowledge gap, we evaluated pediatric asthma admission rates within the 2 Canadian provinces of Manitoba and Saskatchewan, which have similarly sized pediatric populations and substantially different physician densities. Methods This was a retrospective cross-sectional cohort study. Health regions defined by the provincial governments, have, in turn, been classified into “peer groups” by Statistics Canada, on the basis of common socio-economic characteristics and socio-demographic determinants of health. To study the relationship between the distribution of the pediatric workforce and health outcomes in Canadian children, asthma admission rates within comparable peer group regions in both provinces were examined by combining multiple national and provincial health databases. We generated physician density maps for general practitioners, and general pediatricians practicing in Manitoba and Saskatchewan in 2011. Results At the provincial level, Manitoba had 48.6 pediatricians/100,000 child population, compared to 23.5/100,000 in Saskatchewan. There were 3.1 pediatric asthma specialists/100,000 child population in Manitoba and 1.4/100,000 in Saskatchewan. Among peer-group A, the differences were even more striking. A significantly higher number of patients were admitted in Saskatchewan (590.3/100,000 children) compared to Manitoba (309.3/100,000, p < 0.0001). Conclusions Saskatchewan, which has a lower pediatrician and pediatric asthma specialist supply, had a higher asthma admission rate than Manitoba. Our data suggest that there is an inverse relationship between asthma admissions and pediatrician and asthma specialist supply.
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Affiliation(s)
- Guido Filler
- Departments of Peediatrics, Children's Hospital at London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada. .,Departments of Medicine, Children's Hospital at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. .,Departments of Pathology & Laboratory Medicine, Children's Hospital at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Erik Bourdon
- The Canadian Institute for Health Information (CIHI), Ottawa, Ontario, Canada
| | - Sarah Ann Jones
- Departments of Peediatrics, Children's Hospital at London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada.,Departments of Surgery, Children's Hospital at London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Laurentiu Givelichian
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jason Gilliland
- Departments of Peediatrics, Children's Hospital at London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada.,Department of Geography, University of Western Ontario, London, Ontario, Canada
| | | | - Elaine Orrbine
- Paediatric Chairs of Canada (PCC), Ottawa, Ontario, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, University Laval, Faculty of Medicine, Quebec City, Quebec, Canada
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Beltempo M, Lacroix G, Cabot M, Blais R, Piedboeuf B. Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants. J Perinatol 2018; 38:175-180. [PMID: 28933776 DOI: 10.1038/jp.2017.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/31/2017] [Revised: 07/14/2017] [Accepted: 08/11/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. STUDY DESIGN Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight <1000 g admitted at a 56 bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). RESULTS Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). CONCLUSION High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.
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Affiliation(s)
- M Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - G Lacroix
- Department of Economics, Université Laval, Ville de Québec, QC, Canada
| | - M Cabot
- Department of Pediatrics, CHU de Québec and Université Laval, Ville de Québec, QC, Canada
| | - R Blais
- Department of Health Administration, Université de Montreal, Montreal, QC, Canada
| | - B Piedboeuf
- Department of Pediatrics, CHU de Québec and Université Laval, Ville de Québec, QC, Canada
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Beltempo M, Viel-Thériault I, Thibeault R, Julien AS, Piedboeuf B. C-reactive protein for late-onset sepsis diagnosis in very low birth weight infants. BMC Pediatr 2018; 18:16. [PMID: 29382319 PMCID: PMC5791164 DOI: 10.1186/s12887-018-1002-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 01/09/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Late-onset sepsis in very low birth weight (VLBW) infants is a diagnostic challenge. We aimed to evaluate the diagnostic utility of the C-Reactive protein (CRP) and the complete blood count (CBC) for late-onset sepsis in VLBW infants. METHODS In a 5-year retrospective cohort of 416 VLBW infants born at less than 1500 g, there were 590 separate late-onset sepsis evaluations. CRP and CBC were drawn at time of initial blood culture (T0), at 16-24 h (T24) and 40-48 h (T48) after. The positive cut-off values for abnormal values were the following: CRP ≥10 mg/L and CBC with at least one anomaly, including white blood cell count < 5000/mm3, immature neutrophil/total neutrophil ratio > 0.10, or platelet count < 100,000/uL. Sensitivity and specificity for predicting late-onset sepsis were calculated for each laboratory test and their combinations. Receiver operating characteristics curves were obtained for each test and for the absolute change from T0 to T24 in the laboratory value of CRP, white blood cell count and immature neutrophil/total neutrophil. RESULTS At T0, combining the CBC and the CRP had the highest sensitivity of 66% (95% confidence interval [CI], 58-73) compared to both individual tests for predicting late onset sepsis. At T24, CRP's sensitivity was 84% (95% CI, 78-89) and was statistically higher than the CBC's 59% (95% CI, 51-67). The combination of CBC at T0 and CRP at T24 offered the greatest sensitivity of 88% (95% CI, 82-92) and negative predictive value 93% (95% CI, 89-96), with fewer samples, compared to any other combination of tests. The area under the curve for the change in the white blood cell count from T0 to T24 was 0.82. CONCLUSION At initial sepsis evaluation (T0), both CBC and CRP should be performed to increase sensitivity. A highly negative predictive value is reachable with only two tests: a CBC at T0 and a CRP a T24.
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Affiliation(s)
- Marc Beltempo
- McGill University Health Centre, Montreal, QC, Canada
| | - Isabelle Viel-Thériault
- Département de pédiatrie, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, 2705 Boulevard Laurier, QC, Québec, G1V 4G2, Canada.
| | - Roseline Thibeault
- Département de pédiatrie, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, 2705 Boulevard Laurier, QC, Québec, G1V 4G2, Canada
| | - Anne-Sophie Julien
- Centre de recherche du CHU de Québec, Université Laval, QC, Québec, Canada
| | - Bruno Piedboeuf
- Département de pédiatrie, Centre Mère-Enfant Soleil du CHU de Québec, Université Laval, 2705 Boulevard Laurier, QC, Québec, G1V 4G2, Canada.,Centre de recherche du CHU de Québec, Université Laval, QC, Québec, Canada
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Shah PS, McDonald SD, Barrett J, Synnes A, Robson K, Foster J, Pasquier JC, Joseph KS, Piedboeuf B, Lacaze-Masmonteil T, O'Brien K, Shivananda S, Chaillet N, Pechlivanoglou P. The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families. CMAJ Open 2018; 6:E44-E49. [PMID: 29348260 PMCID: PMC5878956 DOI: 10.9778/cmajo.20170128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/22/2022] Open
Abstract
BACKGROUND Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. INTERPRETATION These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates.
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Affiliation(s)
- Prakesh S Shah
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Sarah D McDonald
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jon Barrett
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Anne Synnes
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Kate Robson
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jonathan Foster
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Jean-Charles Pasquier
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - K S Joseph
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Bruno Piedboeuf
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Thierry Lacaze-Masmonteil
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Karel O'Brien
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Sandesh Shivananda
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Nils Chaillet
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
| | - Petros Pechlivanoglou
- Affiliations: Department of Paediatrics (Shah, O'Brien), Mount Sinai Hospital; Department of Pediatrics (Shah, O'Brien), University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact (McDonald), McMaster University, Hamilton, Ont.; Women and Babies Program (Barrett), Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ont.; Department of Pediatrics (Synnes, Shivananda), University of British Columbia, Vancouver, BC; Canadian Premature Babies Foundation (Robson, Foster), Toronto, Ont.; Women and Babies Program (Robson), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Obstetrics and Gynecology (Pasquier), Université de Sherbrooke, Sherbrooke, Que.; Department of Obstetrics and Gynaecology (Joseph), University of British Columbia, Vancouver, BC; Department of Pediatrics (Piedboeuf), Université Laval, Québec, Que.; Department of Pediatrics (Lacaze-Masmonteil), Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Obstetrics and Gynecology (Chaillet), Université Laval, Québec, Que.; Child Health Evaluative Sciences (Pechlivanoglou), The Hospital for Sick Children, Toronto, Ont
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Beltempo M, Piedboeuf B, Platt RW, Barrington K, Bizgu V, Shah PS. Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants. Am J Perinatol 2017; 34:1396-1404. [PMID: 28582791 DOI: 10.1055/s-0037-1603687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/19/2022]
Abstract
Objective To assess the association of the 2011 Quebec provincial resident duty hour reform, which reduced the maximum consecutive hours worked by all residents from 24 to 16 hours, with neonatal outcomes.
Study Design Retrospective observational study of 4,271 infants born between 23 and 32 weeks, admitted at five Quebec neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network (CNN) between 2008 and 2015 was conducted. Adjusted odds ratios (AORs) were calculated to compare mortality and the composite outcome of mortality or major morbidity before and after the implementation of the duty hour reform.
Results The mortality rate was 8.4% (218/2,598) before the resident duty hour reform and 8.6% (182/2,123) after the reform (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.83–1.26). The composite outcome rate was 32% (830/2,598) before the duty hour reform and 29% (615/2,123) after the reform (OR = 0.87, 95% CI = 0.77–0.98). In the adjusted analyses, the resident call-hour reform was not associated with a significant change in mortality (AOR = 1.17, 95% CI = 0.91–1.50) or composite outcome (AOR = 0.87, 95% CI = 0.74–1.03).
Conclusion Reducing residents' duty hours from 24 to 16 hours in Quebec was not associated with a difference in mortality or the composite outcome of very preterm infants.
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Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada.,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Keith Barrington
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Victoria Bizgu
- Department of Neonatology, Jewish General Hospital, Montreal, Québec, Canada
| | - Prakesh S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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Beltempo M, Blais R, Lacroix G, Cabot M, Piedboeuf B. Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care-Associated Infections in the NICU. Am J Perinatol 2017; 34:996-1002. [PMID: 28376546 DOI: 10.1055/s-0037-1601459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/19/2022]
Abstract
Objective This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database "Logibec" and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05-2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47-1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67-1.99, Q4 vs. Q1). Conclusion Nursing overtime is associated with higher odds of HCAI in the NICU.
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Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Régis Blais
- Department of Health Administration, Université de Montreal, Montreal, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Quebec, Canada
| | - Michèle Cabot
- Department of Pediatrics, CHU de Québec, Université Laval, Quebec, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, CHU de Québec, Université Laval, Quebec, Canada
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Olivier F, Nadeau S, Bélanger S, Julien AS, Massé E, Ali N, Caouette G, Piedboeuf B. Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: A multicentre randomized control trial. Paediatr Child Health 2017; 22:120-124. [PMID: 29479196 PMCID: PMC5804903 DOI: 10.1093/pch/pxx033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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] Open
Abstract
BACKGROUND Minimally invasive surfactant therapy (MIST) is a new strategy to avoid mechanical ventilation (MV) in respiratory distress syndrome. The primary aim of this study was to test MIST as a means of avoiding MV exposure and pneumothorax occurrence in moderate and late preterm infants (32 to 36 weeks' gestational age). METHODS This was a randomized controlled trial including three Canadian centres. Patients were randomized to standard management or to the intervention if they required nasal continuous positive airway pressure of 6 cm H2O and 35% FiO2 in the first 24 hours of life. Patients from the intervention group received MIST immediately after inclusion. The primary outcome was either need for MV or development of a pneumothorax requiring a chest tube. To ensure that clinicians were not biased toward delaying intubation in the intervention group, clinical failure criteria were also used as a primary outcome. The primary outcome was analyzed using bivariate and multivariate logistic regressions. RESULTS Among 45 randomized patients, 24 were assigned to MIST and 21 to standard management. Eight infants (33%) from the intervention group met the primary outcome criteria versus 19 (90%) in the control group (absolute risk reduction 0.57, 95% confidence interval 0.54 to 0.60). One patient in each group reached the primary outcome because of pneumothorax occurrence. The other patients were exposed to MV. None of the patients reached the clinical failure criteria. CONCLUSION MIST for respiratory distress syndrome management in moderate and late preterm infants was associated with a significant reduction of MV exposure and pneumothorax occurrence.
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Affiliation(s)
- François Olivier
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Sophie Nadeau
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Sylvie Bélanger
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Anne-Sophie Julien
- Plateforme de la recherche clinique, Centre de recherche du CHU de Québec - Université Laval, Hôpital Saint-François d'Assise, Québec City, Québec
| | - Edith Massé
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Québec
| | - Nabeel Ali
- Department of Pediatrics, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec
| | - Georges Caouette
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
| | - Bruno Piedboeuf
- Department of Pediatrics, CHU de Québec - Université Laval, Québec City, Québec
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Olivier F, Bertelle V, Shah PS, Drolet C, Piedboeuf B, Piedboeuf B. Association between birth route and late-onset sepsis in very preterm neonates. J Perinatol 2016; 36:1083-1087. [PMID: 27583393 DOI: 10.1038/jp.2016.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/01/2016] [Revised: 07/19/2016] [Accepted: 07/27/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the association between birth route and late-onset sepsis (LOS), and coagulase-negative Staphylococcal (CONS)-related LOS in preterm neonates. STUDY DESIGN In this observational study, data from 20,038 infants born between 22 and 32 weeks' gestation and admitted to Canadian neonatal intensive care units between 2010 and 2014 were analyzed retrospectively. The impact of birth route on LOS was assessed using univariate analysis and multiple logistic regression. RESULTS A total of 8218 neonates were born via vaginal route and 11,820 via cesarean section. Incidence rates of LOS for infants born vaginally and via a cesarean section were 13.1 and 13.2%, respectively, and there was no significant difference in odds of LOS between the groups (adjusted odds ratio (AOR): 0.99; 95% CI 0.87 to 1.12); however, the odds of CONS sepsis were higher in the cesarean group (AOR: 1.15; 95% CI: 1.01 to 1.32). CONCLUSION Birth route did not have an impact on LOS, but was associated with CONS-related LOS.
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Affiliation(s)
- F Olivier
- Department of Pediatrics, Université Laval, CHU de Québec, Québec, Québec, Canada
| | - V Bertelle
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Québec, Canada
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital, Maternal-Infant Care Research Centre, Toronto, Ontario, Canada
| | - C Drolet
- Department of Pediatrics, Université Laval, CHU de Québec, Québec, Québec, Canada
| | - B Piedboeuf
- Department of Pediatrics, Université Laval, CHU de Québec, Québec, Québec, Canada
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Melamed N, Shah J, Yoon EW, Pelausa E, Lee SK, Shah PS, Murphy KE, Shah PS, Harrison A, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Aziz K, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Shivananda S, Da Silva O, Nwaesei C, Lee KS, 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, Lee SK. The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth. Am J Obstet Gynecol 2016; 215:482.e1-9. [PMID: 27260974 DOI: 10.1016/j.ajog.2016.05.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Data regarding the effects of antenatal corticosteroids in twin pregnancies are limited because of the insufficient number of women with twins enrolled in randomized controlled trials on antenatal corticosteroids. Furthermore, the interpretation of available data is limited by the fact that the interval from the administration of antenatal corticosteroids to delivery is greater than 7 days in a large proportion of twins, a factor that has been shown to affect the efficacy of antenatal corticosteroids and has not been controlled for in previous studies. OBJECTIVE The objective of the study was to compare neonatal mortality and morbidity in preterm twins receiving a complete course of antenatal corticosteroids 1-7 days before birth to those who did not receive antenatal corticosteroids and to compare these outcome effects with those observed in singletons. STUDY DESIGN We performed a retrospective cohort study using data collected on singleton and twin neonates born between 24(0/7) and 33(6/7) weeks' gestational age and were admitted to tertiary neonatal units in Canada between 2010 and 2014. A comparison of neonatal outcomes between twin neonates who received a complete course of antenatal corticosteroids 1-7 days before birth (n = 1758) and those who did not receive antenatal corticosteroids (n = 758) and between singleton neonates who received a complete course of antenatal corticosteroids 1-7 days before birth (n = 4638) and those did not receive antenatal corticosteroids (n = 2312) was conducted after adjusting for gestational age, sex, hypertension, outborn status, small for gestational age, parity, and cesarean birth. Adjusted odds ratios and 95% confidence intervals for various neonatal outcomes were calculated. RESULTS Administration of a complete course of antenatal corticosteroids within 1-7 days before birth in both twins and singletons was associated with similar reduced odds of neonatal death (for twins adjusted odds ratio 0.42 [95% confidence interval, 0.24-0.76] and for singletons adjusted odds ratios, 0.38 [95% confidence interval, 0.28-0.50]; P = .7 for comparison of twins vs singletons), mechanical ventilation (for twins adjusted odds ratio, 0.47 [95% confidence interval, 0.35-0.63] and for singletons adjusted odds ratio, 0.47 [95% confidence interval, 0.41-0.55]; P = .9), respiratory distress syndrome (for twins adjusted odds ratio, 0.53 [95% confidence interval, 0.40-0.69], and for singletons adjusted odds ratio, 0.54 [95% confidence interval, 0.47-0.62]; P = .9) and severe neurological injury (for twins adjusted odds ratio, 0.50 [95% confidence interval, 0.30-0.83] and for singletons adjusted odds ratio, 0.45 [95% confidence interval, 0.34-0.59]; P = .7). Administration of a complete course of antenatal corticosteroids was not associated with a reduced odds of bronchopulmonary dysplasia, severe retinopathy of prematurity, or necrotizing enterocolitis in both twins and singletons. CONCLUSION Administration of a complete course of antenatal corticosteroids 1-7 days before birth in twin pregnancies is associated with a clinically significant decrease in neonatal mortality, short-term respiratory morbidity, and severe neurological injury that is similar in magnitude to that observed among singletons.
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Dorfeuille N, Morin V, Tétu A, Demers S, Laforest G, Gouin K, Piedboeuf B, Bujold E. Vaginal Fluid Inflammatory Biomarkers and the Risk of Adverse Neonatal Outcomes in Women with PPROM. Am J Perinatol 2016; 33:1003-7. [PMID: 27120475 DOI: 10.1055/s-0036-1582130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/21/2022]
Abstract
Objective The purpose of this study was to evaluate the predictive value of vaginal fluid biomarkers for chorioamnionitis and adverse perinatal outcomes in women with preterm premature rupture of membranes (PPROM). Methods We recruited women with PPROM, without clinical chorioamnionitis, between 22 and 36 weeks' gestation. Vaginal fluid was collected on admission for the measurement of metalloproteinase-8 (MMP-8), interleukin-6 (IL-6), lactate, and glucose concentration. Placental pathology and neonatal charts were reviewed. Primary outcomes were histological chorioamnionitis and adverse neonatal neurological outcomes (intraventricular hemorrhage grade 2 or 3, periventricular leukomalacia, or hypoxic/ischemic encephalopathy). Linear regression analyses were used to adjust for gestational age at PPROM. Results Twenty-seven women were recruited at a mean gestational age of 31.6 ± 3.1 weeks, including 25 (93%) with successful collection of vaginal fluid sample. Histological chorioamnionitis and adverse neonatal neurological outcomes were observed in nine (33%) and four (15%) cases, respectively. In univariate analysis, MMP-8, IL-6, glucose, and lactate concentrations in vaginal fluid were associated with the risk of chorioamnionitis but not anymore after adjustment for gestational age at PPROM. MMP-8 concentration was the only biomarker associated with adverse neurological outcome, and it remained significant after adjustment for gestational age at PPROM (p = 0.02). Conclusion Vaginal fluid inflammatory biomarkers at admission for PPROM could predict adverse perinatal outcomes.
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Affiliation(s)
- Nydia Dorfeuille
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Valérie Morin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Amélie Tétu
- Centre de recherche du CHU de Québec, Université Laval, Québec City, Canada
| | - Suzanne Demers
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Geneviève Laforest
- Centre de recherche du CHU de Québec, Université Laval, Québec City, Canada
| | - Katy Gouin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Emmanuel Bujold
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec City, Canada
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Afifi J, Vincer M, Shah V, Ye XY, Shah PS, Barrington K, Kelly E, Piedboeuf B, El-Naggar W. Can We Predict Post-Hemorrhagic Ventricular Dilatation in Preterm Infants with Severe Intraventricular Hemorrhage? Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e51a] [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
BACKGROUND: The incidence of post-hemorrhagic ventricular dilatation (PHVD) remains high in preterm infants. Little is known about the risk factors for PHVD in infants with severe intraventricular hemorrhage (IVH).
OBJECTIVES: To determine the predictors of PHVD among preterm infants with severe IVH.
DESIGN/METHODS: We conducted a retrospective review of all pre-term infants (22+0 - 32+6 weeks) who were admitted to NICUs participating in the Canadian Neonatal Network between 2010 and 2014. Infants with severe IVH (IVH with ventricular dilatation or parenchymal bleeding) who survived ≥ 72 hours were included. Perinatal and neonatal risk factors were compared between infants with and without PHVD (lateral ventricles >10 mm).
RESULTS: Of 16600 eligible infants, 1964 (11.8%) developed severe IVH. Of 1815 infants with severe IVH who survived ≥72 hours, 616 (34%) developed PHVD. Factors associated with occurrence of PHVD include: lower gestational age, small for gestational age, low 5 minute Apgar score, SNAPII score>20, surfactant therapy, high frequency oscillatory ventilation (HFOV), inotropes and occurrence of pneumothorax. [table 1]. There were no differences between both groups in relation to antenatal steroids, multiple pregnancy, mode of delivery, birth weight, gender or the proportion received prophylactic indomethacin. Multivariate analysis showed low five-minute Apgar score and HFOV to be independent predictors of PHVD while maternal magnesium sulfate and small for gestation (SGA) to be protective against PHVD.[table 2].
CONCLUSION: Our study identified factors involved in the prediction of PHVD in a national cohort of preterm infants. The mechanisms by which these factors may impact PHVD need further investigation.
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Afifi J, Vincer M, Shah V, Ye X, Shah P, Barrington K, Piedboeuf B, Kelly E, El-Naggar W. Epidemiology of Posthemorrhagic Ventricular Dilatation in Canadian Neonatal Intensive Care Units. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e89] [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
BACKGROUND: Severe intraventricular hemorrhage (IVH) is a common cause of neonatal morbidity and mortality .The incidence and management of post-hemorrhagic ventricular dilatation (PHVD) vary among different centres.
OBJECTIVES: To assess the incidence, temporal trend, management and associated outcomes of PHVD in Canadian NICUs.
DESIGN/METHODS: We conducted a retrospective review of all pre-term infants (22+0 -32+6 weeks) who were admitted to NICUs participating in the Canadian Neonatal Network between 2010 and 2014. Infants with severe IVH (IVH with ventricular dilatation or parenchymal bleeding) who survived ≥ 72 hours were included. We compared the rates of severe IVH, PHVD and VP shunting between the 5 Canadian regions. Short-term outcomes of infants who developed PHVD (ventricles size ≥10 mm) were compared with those who did not.
RESULTS: Of 16600 eligible infants, 1964 (11.8%) developed severe IVH. Of 1815 infants with severe IVH who survived ≥72 hours, 616 (34%) developed PHVD and 91 (5%) treated with VP shunt. No significant difference in the incidence of severe IVH, PHVD or VP shunting over the last five years was noted. There was a statistically significant difference in the rates of severe IVH (p<0.0001) and PHVD (p=0.02) among the 5 Canadian regions. VP shunts rates were variable with some Canadian regions with higher rates of PHVD had low rates of VP shunts. [figure 1]. Infants with PHVD had significantly higher mortality and short term morbidities. [table 1]. On regression analysis, PHVD is an independent predictor of death in infants with severe IVH [adjusted OR 1.55, 95% CI (1.18, 2.04)]. Infants with VP shunt had significantly higher rates of severe ROP (p<0.0001), meningitis (p<0.0001), and hospitalization (89 vs 41 days, p<0.0001).
CONCLUSION: PHVD is an independent predictor of death and is associated with adverse short- term outcomes. Variability exists between different regions in managing PHVD. Further studies are needed to investigate the impact of this variability on long-term outcomes.
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Dorfeuille N, Morin V, Tétu A, Laforest G, Piedboeuf B, Gouin K, Bujold E. 538: Vaginal fluid inflammatory biomarkers and the risk of adverse neonatal outcomes in women with PPROM. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.582] [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: 10/22/2022]
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Olivier F, Nadeau S, Caouette G, Piedboeuf B. Association between Apnea of Prematurity and Respiratory Distress Syndrome in Late Preterm Infants: An Observational Study. Front Pediatr 2016; 4:105. [PMID: 27725928 PMCID: PMC5036403 DOI: 10.3389/fped.2016.00105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/22/2016] [Accepted: 09/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Late preterm infants (34-36 weeks' gestation) remain a population at risk for apnea of prematurity (AOP). As infants affected by respiratory distress syndrome (RDS) have immature lungs, they might also have immature control of breathing. Our hypothesis is that an association exists between RDS and AOP in late preterm infants. OBJECTIVE The primary objective of this study was to assess the association between RDS and AOP in late preterm infants. The secondary objective was to evaluate if an association exists between apparent RDS severity and AOP. METHODS This retrospective observational study was realized in a tertiary care center between January 2009 and December 2011. Data from late preterm infants who presented an uncomplicated perinatal evolution, excepted for RDS, were reviewed. Information related to AOP and RDS was collected using the medical record. Odds ratios were calculated using a binary logistic regression adjusted for gestational age and sex. RESULTS Among the 982 included infants, 85 (8.7%) had an RDS diagnosis, 281 (28.6%) had AOP diagnosis, and 107 (10.9%) were treated with caffeine for AOP. There was a significant association between AOP treated with caffeine and RDS for all infants (OR = 3.3, 95% CI: 2.0-5.7). There was no association between AOP and RDS in 34 weeks infants [AOR: 1.6 (95% CI: 0.7-3.8)], but an association remains for 35 [AOR: 5.7 (95% CI: 2.5-13.4)] and 36 [OR = 7.8 (95% CI: 3.2-19.4)] weeks infants. No association was found between apparent RDS severity and AOP, regarding mean oxygen administration duration or complications associated with RDS. CONCLUSION The association between RDS and AOP in late preterm infants reflects that patients affected by RDS are not only presenting lung immaturity but also respiratory control immaturity. Special consideration should be given before discontinuing monitoring after RDS resolution in those patients.
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Affiliation(s)
- François Olivier
- Service of Neonatology, Department of Pediatrics, CHU de Québec-Université Laval , Quebec, QC , Canada
| | - Sophie Nadeau
- Service of Neonatology, Department of Pediatrics, CHU de Québec-Université Laval , Quebec, QC , Canada
| | - Georges Caouette
- Service of Neonatology, Department of Pediatrics, CHU de Québec-Université Laval , Quebec, QC , Canada
| | - Bruno Piedboeuf
- Service of Neonatology, Department of Pediatrics, CHU de Québec-Université Laval , Quebec, QC , Canada
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Olivier F, Wieckowska A, Piedboeuf B, Alvarez F. Cholestasis and Hepatic Failure in a Neonate: A Case Report of Severe Pyruvate Kinase Deficiency. Pediatrics 2015; 136:e1366-8. [PMID: 26459649 DOI: 10.1542/peds.2015-0834] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Accepted: 07/27/2015] [Indexed: 11/24/2022] Open
Abstract
Unexpected severe cholestasis is part of the presentation in some neonates with hemolytic anemia but is usually self-resolving. Here we report the case of a neonate with pyruvate kinase deficiency (PKD) who presented severe hemolytic anemia at birth, characterized by a rapidly progressive and severe cholestasis with normal γ-glutamyl transpeptidase level associated with hepatic failure. After an extensive investigation to rule out contributing conditions explaining the severity of this patient's clinical presentation, PKD has remained the sole identified etiology. The patient abruptly died of sepsis at 3 months of age before a planned splenectomy and ongoing evaluation for liver transplantation. To the best of our knowledge, only a few similar cases of severe neonatal presentation of PKD complicated with severe hepatic failure and cholestasis have been reported.
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Affiliation(s)
| | - Anna Wieckowska
- Gastroenterology, Department of Pediatrics, CHU de Québec, Université Laval, Québec City, Québec, Canada; and
| | | | - Fernando Alvarez
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Sainte Justine Hospital, Montréal, Québec, Canada
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Lyu Y, Shah PS, Ye XY, Warre R, Piedboeuf B, Deshpandey A, Dunn M, Lee SK. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation. JAMA Pediatr 2015; 169:e150277. [PMID: 25844990 DOI: 10.1001/jamapediatrics.2015.0277] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Neonatal hypothermia has been associated with higher mortality and morbidity; therefore, thermal control following delivery is an essential part of neonatal care. Identifying the ideal body temperature in preterm neonates in the first few hours of life may be helpful to reduce the risk for adverse outcomes. OBJECTIVES To examine the association between admission temperature and neonatal outcomes and estimate the admission temperature associated with lowest rates of adverse outcomes in preterm infants born at fewer than 33 weeks' gestation. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study at 29 neonatal intensive care units in the Canadian Neonatal Network. Participants included 9833 inborn infants born at fewer than 33 weeks' gestation who were admitted between January 1, 2010, and December 31, 2012. EXPOSURE Axillary or rectal body temperature recorded at admission. MAIN OUTCOMES AND MEASURES The primary outcome was a composite adverse outcome defined as mortality or any of the following: severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infection. The relationships between admission temperature and the composite outcome as well as between admission temperature and the components of the composite outcome were evaluated using multivariable analyses. RESULTS Admission temperatures of the 9833 neonates were distributed as follows: lower than 34.5°C (1%); 34.5°C to 34.9°C (1%); 35.0°C to 35.4°C (3%); 35.5°C to 35.9°C (7%); 36.0°C to 36.4°C (24%); 36.5°C to 36.9°C (38%); 37.0°C to 37.4°C (19%); 37.5°C to 37.9°C (5%); and 38.0°C or higher (2%). After adjustment for maternal and infant characteristics, the rates of the composite outcome, severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, and nosocomial infection had a U-shaped relationship with admission temperature (α > 0 [P < .05]). The admission temperature at which the rate of the composite outcome was lowest was 36.8°C (95% CI, 36.7°C-37.0°C). Rates of severe neurological injury, severe retinopathy of prematurity, necrotizing enterocolitis (95% CI, 36.3°C-36.7°C), bronchopulmonary dysplasia, and nosocomial infection (95% CI, 36.9°C-37.3°C) were lowest at admission temperatures ranging from 36.5°C to 37.2°C. CONCLUSIONS AND RELEVANCE The relationship between admission temperature and adverse neonatal outcomes was U-shaped. The lowest rates of adverse outcomes were associated with admission temperatures between 36.5°C and 37.2°C.
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Affiliation(s)
- Yanyu Lyu
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada3Capital Institute of Pediatrics, Beijing, China
| | - Prakesh S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ruth Warre
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Bruno Piedboeuf
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | - Akhil Deshpandey
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
| | - Michael Dunn
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada6Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada2Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Beltempo M, Lacroix G, Cabot M, Beauchesne V, Piedboeuf B. 6: Patient Volume and Nursing Overtime Increased Risk of Nosocomial Infection in the NICU. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-6] [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: 11/12/2022] Open
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Lyu Y, Shah PS, Ye XY, Piedboeuf B, Deshpandey A, Dunn M, Lee SK. 2: Impact of Admission Temperature on Mortality and Major Morbidities in Very Preterm Infants. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-2] [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: 11/12/2022] Open
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Beltempo M, Lacroix G, Cabot M, Beauchesne V, Piedboeuf B. 34: Nursing Overtime Increases the Risk of Medical Incidents in the NICU. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-33] [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: 11/12/2022] Open
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