scholarly journals Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Doetsch ◽  
S C S Marques ◽  
T Krafft ◽  
H Barros
Keyword(s):  
Private Sector ◽  
Preterm Infants ◽  
Economic Crisis ◽  
Healthcare Quality ◽  
Wage Distribution ◽  
Very Preterm Infants ◽  
Socioeconomic Determinants ◽  
Very Preterm ◽  
Secondary Stage ◽  
The Impact

Abstract The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care costs (2011-2014), substantially affected healthcare delivery and occupational environment of Healthcare Professionals (HCPs). This study aims to analyse the impact observed by HCPs of the economic crisis and EAP on equitable quality of perinatal healthcare for very preterm infants in Portugal. A Qualitative study design with 21 HCPs in clinical settings equally distributed among Portuguese mainland were selected according to their response. Semi-structured interviews were conducted between October 2018-April 2019 until saturation point was achieved. A content analysis was performed using Nvivo2011 software. Preliminary results on macro-socioeconomic determinants, classified and conceptualized into a three-stage-effect framework, disclosed an interrelation between factors impacting perinatal healthcare quality, according to HCPs. Primary-stage: increase in working hours and patient-ratio per HCPs, cuts in salaries and investment, increasing waiting time and HCPs demotivation. Secondary-stage: burnout, work-absence, time constraints, decreasing quality and consultation availability. Tertiary-stage: HCPs Brain-drain to private sector, double-shifts in public-private sector, increasing inadequacy of transmissivity within sector communication. The economic crisis and EAP were perceived to have modified equitable perinatal healthcare quality for very preterm infants in Portugal. Increased private-public sector transparency to maximise quality assurance, equal HCP wage distribution to sustain capability, strengthening of social maternity protection strategies to enhance socioeconomic equity in perinatal healthcare, is recommended. Key messages The added value is the disclosure of an in-depth understanding on the interrelation of macro-socioeconomic determinants and healthcare permitting a distinct representation from quantitative methods. The non-linearity between policy response and expected outcomes chiefly complements its comprehension and demonstrates its relevance for further research on assessing effects of austerity measures.

scholarly journals The Impact of Neonatal Morbidities on Smooth Pursuit Eye Movements in Very Preterm Infants

2011 ◽  
Vol 70 ◽  
pp. 352-352 ◽  
Author(s):  
K Strand Brodd ◽  
K Rosander ◽  
H Grönqvist ◽  
G Holmström ◽  
B Strömberg ◽  
...  
Keyword(s):  
Eye Movements ◽  
Preterm Infants ◽  
Smooth Pursuit ◽  
Smooth Pursuit Eye Movements ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pursuit Eye Movements ◽  
The Impact

Misdiagnosing Midgut Volvulus in Very Preterm Infants: What is the Impact of Delay Before Surgery?

2020 ◽  
Vol 88 (1) ◽  
pp. 89-90
Author(s):  
Louise Montalva ◽  
Liza Ali ◽  
Alice Heneau ◽  
Florence Julien-Marsollier ◽  
Valérie Biran ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Midgut Volvulus ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals The impact of prenatal and neonatal infection on neurodevelopmental outcomes in very preterm infants

2014 ◽  
Vol 34 (10) ◽  
pp. 741-747 ◽  
Author(s):  
I Lee ◽  
J J Neil ◽  
P C Huettner ◽  
C D Smyser ◽  
C E Rogers ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Infection ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals Introduction of a Quality Improvement Bundle Is Associated with Reduced Exposure to Mechanical Ventilation in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Stacey Chi-Yan Lo ◽  
Risha Bhatia ◽  
Calum T. Roberts
Keyword(s):  
Mechanical Ventilation ◽  
Quality Improvement ◽  
Preterm Infants ◽  
Demographic Data ◽  
Neonatal Morbidity ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Antenatal Steroids ◽  
Cord Clamping ◽  
The Impact

<b><i>Introduction:</i></b> Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants (VPTIs). We assessed the impact of a quality improvement (QI) bundle in VPTIs (&#x3c;32 week gestation) on exposure to MV. <b><i>Methods:</i></b> We introduced a QI bundle consisting of deferred cord clamping (DCC), nasal bubble continuous positive airway pressure (bCPAP) in the delivery room (DR), and minimally invasive surfactant therapy (MIST). We compared respiratory outcomes and neonatal morbidity in historical pre-QI (July–December 2017) and prospective post-QI (February–July 2019) cohorts (QICs) of VPTIs. We pre-specified an adjusted analysis to account for the effects of gestational age, sex, antenatal steroids, and any demographic data that significantly differed between cohorts. <b><i>Results:</i></b> The pre-QI and post-QICs included 87 and 98 VPTIs, respectively. The post-QIC had decreased rates of MV in the DR (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI] 0.09–0.71), in the first 72 h of life (aOR 0.27, 95% CI 0.11–0.62) and during admission (aOR 0.28, 95% CI 0.12–0.66). Rates of BPD, combined BPD/death, and BPD severity were similar. The post-QIC was less likely to be discharged with home oxygen (aOR 0.27, 95% CI 0.08–0.91). Necrotising enterocolitis grade ≥2 increased (aOR 19.01, 95% CI 1.93–188.6) in the post-QIC. <b><i>Conclusion:</i></b> In this rapid-cycle QI study, implementation of a QI bundle consisting of DCC, early nasal bCPAP, and MIST in VPTIs was associated with reduced rates of MV in the DR, in the first 72 h of life and during admission, and reduced need for home oxygen.

scholarly journals The Impact of Low-Grade Germinal Matrix-Intraventricular Hemorrhage on Neurodevelopmental Outcome of Very Preterm Infants

Neonatology ◽  
2017 ◽  
Vol 112 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Pauline Reubsaet ◽  
Annemieke J. Brouwer ◽  
Ingrid C. van Haastert ◽  
Margaretha J. Brouwer ◽  
Corine Koopman ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Neurodevelopmental Outcome ◽  
Low Grade ◽  
Germinal Matrix ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
The Impact

scholarly journals Preterm birth alters the maturation of the GABAergic system in the human prefrontal cortex

2021 ◽  
Author(s):  
Helene Lacaille ◽  
Claire-Marie Vacher ◽  
Anna A Penn
Keyword(s):  
Prefrontal Cortex ◽  
Preterm Infants ◽  
Gene List ◽  
Gabaergic System ◽  
Developmental Changes ◽  
Term Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Maturation Index ◽  
The Impact

Developmental changes in GABAergic and glutamatergic systems during frontal lobe development have been hypothesized to play a key role in neurodevelopmental disorders seen in children born very preterm or low birth weight, but the associated cellular changes have not yet been identified. Here we studied the molecular development of the GABAergic system specifically in the dorsolateral prefrontal cortex, a region that that has been implicated in neurodevelopmental and psychiatric disorders. The maturation state of the GABAergic system in this region was assessed in human post-mortem brain samples, from term infants ranging in age from 0 to 8 months (n=17 male, 9 female). Gene expression was measured for 47 GABAergic genes and used to calculate a maturation index. This maturation index was significantly more dynamic in male than female infants. To evaluate the impact of premature birth on the GABAergic system development, samples from one-month-old term (n=9 male, 4 female) and one-month corrected-age (n=8 male, 6 female) very preterm infants, were compared using the same gene list and methodology. The maturation index for the GABAergic system was significantly lower in male preterm infants, with major alterations in genes linked to GABAergic function in astrocytes, suggesting astrocytic GABAergic developmental changes as a new cellular mechanism underlying preterm brain injury.

scholarly journals Early versus later initiation of parenteral nutrition for very preterm infants: a propensity score-matched observational study

2021 ◽  
pp. fetalneonatal-2021-322383
Author(s):  
Sabita Uthaya ◽  
Nicholas Longford ◽  
Cheryl Battersby ◽  
Kayleigh Oughham ◽  
Julia Lanoue ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Late Onset ◽  
Controlled Trial ◽  
Absolute Difference ◽  
Research Database ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Randomised Controlled ◽  
The Impact

ObjectiveTo evaluate the impact of timing of initiation of parenteral nutrition (PN) after birth in very preterm infants.DesignPropensity-matched analysis of data from the UK National Neonatal Research Database.Patients65 033 babies <31 weeks gestation admitted to neonatal units in England and Wales between 2008 and 2019.InterventionsPN initiated in the first 2 days (early) versus after the second postnatal day (late). Babies who died in the first 2 days without receiving PN were analysed as ‘late’.Main outcome measuresThe main outcome measure was morbidity-free survival to discharge. The secondary outcomes were survival to discharge, growth and other core neonatal outcomes.FindingsNo difference was found in the primary outcome (absolute rate difference (ARD) between early and late 0.50%, 95% CI −0.45 to 1.45, p=0.29). The early group had higher rates of survival to discharge (ARD 3.3%, 95% CI 2.7 to 3.8, p<0.001), late-onset sepsis (ARD 0.84%, 95% CI 0.48 to 1.2, p<0.001), bronchopulmonary dysplasia (ARD 1.24%, 95% CI 0.30 to 2.17, p=0.01), treated retinopathy of prematurity (ARD 0.50%, 95% CI 0.17 to 0.84, p<0.001), surgical procedures (ARD 0.80%, 95% CI 0.20 to 1.40, p=0.01) and greater drop in weight z-score between birth and discharge (absolute difference 0.019, 95% CI 0.003 to 0.035, p=0.02). Of 4.9% of babies who died in the first 2 days, 3.4% were in the late group and not exposed to PN.ConclusionsResidual confounding and survival bias cannot be excluded and justify the need for a randomised controlled trial powered to detect differences in important functional outcomes.

scholarly journals 42 The Impact of Home Respiratory Support on Developmental Outcomes in Very Preterm Infants

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e17-e18
Author(s):  
Lindsay McRae ◽  
Emily Kieran ◽  
Thuy Mai Luu ◽  
Sandesh Shivananda ◽  
Anne Synnes
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Respiratory Support ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Neurodevelopmental Impairment ◽  
Grade 3 ◽  
The Impact

Abstract Introduction/Background Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied. Objectives This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age. Design/Methods This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at &lt;29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests. Results Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p &lt; 0.01), lower birth weight (mean 781 vs 955 grams, p &lt; 0.01), longer NICU stay (mean 118 vs 76 days, p &lt; 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p &lt; 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p &lt; 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p &lt; 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores &lt;70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p &lt; 0.01) and &gt;3 rehospitalizations (19.8% vs 5.0%, p &lt; 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare. Conclusion Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.

scholarly journals Neonatal Preterm Respiratory Care in Ukraine: An Observational Study of Outcomes in Relation to Timing and Methods of Surfactant Treatment

2020 ◽  
Author(s):  
Dmytro O. Dobryanskyy ◽  
Anna O. Menshykova ◽  
Zoriana V. Salabay ◽  
Olga Y. Detsyk
Keyword(s):  
Clinical Outcomes ◽  
Preterm Infants ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Very Preterm Infants ◽  
Less Invasive ◽  
Very Preterm ◽  
Surfactant Administration ◽  
The Impact ◽  
Cpap Failure

Objective Timely and effective noninvasive respiratory support and surfactant administration are the key determinants of clinical outcomes in very preterm infants. The objective of this study was to evaluate the impact of the changes in clinical practice of surfactant administration on clinical outcomes and the incidence of continuous positive airway pressure (CPAP) failure defined as the need for mechanical ventilation (MV) during the first 5 days of life in preterm infants <32 weeks. Study Design One hundred sixty-five outborn very preterm infants with respiratory distress syndrome (RDS), initially managed on CPAP, were enrolled in a retrospective cohort study. Fifty-two infants treated with surfactant using less invasive or INSURE technique were included in the surfactant group. One hundred thirteen control infants received surfactant only in case of CPAP failure. Results The study groups were similar in gestational age, rates of main obstetric complications, and antenatal steroid prophylaxis. The rate of cesarean delivery was significantly higher but birth weight and need for resuscitation were lower in infants from the surfactant group. Fifty-five infants with CPAP failure (49%) received surfactant after initiation of MV in the control group in comparison with 52 (100%) in the surfactant group (p < 0.001). The incidence of CPAP failure was significantly higher in the control group (49 vs. 27%; p < 0.01) and it occurred earlier (median [interquartile range age: 4 [2–5] vs. 47 [36–99] hours, respectively; p < 0.001). Early surfactant administration significantly and independently affected the probability of CPAP failure (adjusted odds ratio: 0.29, 95% confidence interval: 0.13–0.67; p < 0.01). There were no differences in morbidities between the groups, but CPAP failure was significantly associated with higher morbidity and mortality. Conclusion Adherence to the European RDS guidelines with early rescue, less invasive surfactant administration in very preterm infants decreased the probability of CPAP failure which was significantly associated with higher morbidity and mortality. Key Points

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