64 Association of 24-hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e45-e46
Author(s):  
Anthony Debay ◽  
Prakesh Shah ◽  
Abhay Lodha ◽  
Sandesh Shivananda ◽  
Stephanie Redpath ◽  
...  
Keyword(s):  
Late Onset ◽  
Neurological Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Care Providers ◽  
Chest Compressions ◽  
Perinatal Medicine ◽  
Major Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Care Practices

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Medical team composition at the delivery of high-risk neonates may contribute to better outcomes. The presence of 24-hour (h) in-house staff neonatologist (NN) may improve delivery room (DR) care practices and outcomes. Objectives To assess if 24-h in-house NN coverage is associated with better care practices and outcomes among inborn infants born < 29 weeks GA. Design/Methods Cross-sectional cohort study of 2476 inborn infants born at 23-28 weeks gestation, admitted in 2014-2015 to Canadian Neonatal Network level 3 NICUs with a maternity unit that participated in a 2015 survey on NICU coverage. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders with generalized estimating equations to account for clustering within each site. Results Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). Infants’ characteristics are shown in Table 1. No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving DR chest compressions or epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively) (Table 2). 24-h fellow coverage was associated with higher odds of normothermia (36.5°C-37.2°C) on admission (AOR 2.26, 95% CI 1.51-3.37) compared to 24-h NN coverage (Table 2). Rates of mortality or major morbidity did not differ significantly among the three groups: NN, 63% (249/395); fellow, 64% (1092/1700); no NN/fellow, 70% (266/381). Compared to 24-h NN coverage, 24-h fellow coverage was associated with lower odds of mortality (AOR 0.62, 95% CI, 0.43-0.88) (Table 2). Conclusion 24-h in-house NN coverage was associated with lower rates of DR chest compressions or epinephrine use; however, it was not associated with death and/or major morbidity. These results are from a survey linked cohort, and data on the actual presence of individuals in NICU/resuscitation is unknown. Future prospective research on care providers present in the NICU, and its impact on outcomes, is needed.

Effect of an Educational Presentation about Extremely Preterm Infants on Knowledge and Attitudes of Health Care Providers

2017 ◽  
Vol 34 (10) ◽  
pp. 0982-0989 ◽  
Author(s):  
Stefani Doucette ◽  
Brigitte Lemyre ◽  
Thierry Daboval ◽  
Sandra Dunn ◽  
Salwa Akiki ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Survival Rates ◽  
Care Providers ◽  
Perinatal Medicine ◽  
Knowledge And Attitudes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Before And After

Objective To determine healthcare providers' knowledge (HCP) about survival rates of extremely preterm infants (EPI) and attitudes toward resuscitation before and after an educational presentation and, to examine the relationship between knowledge and attitudes toward resuscitation. Study Design Participants completed a survey before and after attending a presentation detailing evidence-based estimates of survival rates and surrounding ethical issues. Respondents included neonatologists, obstetricians, pediatricians, maternal-fetal medicine specialists, trainees in pediatrics, obstetrics, neonatal-perinatal medicine and neonatal and obstetrical nurses. Results In total, 166 participants attended an educational presentation and 130 participants completed both pre- and postsurveys (response rate 78%). Prepresentation, for all gestations, ≤ 50% of respondents correctly identified survival/intact survival rates. Postpresentation, correct responses regarding survival/intact survival rates ranged from 49 to 86% (p < 0.001) and attitudes shifted toward being more likely to resuscitate at all gestations regardless of parental wishes. There was a weak-to-modest relationship (Spearman's coefficient 0.24–0.40, p < 0.001–0.004) between knowledge responses and attitudes. Conclusion Attendance at an educational presentation did improve HCP knowledge about survival and long term outcomes for EPI, but HCP still underestimated survival and were not always willing to resuscitate in accordance with parental wishes. These findings may represent barriers to some experts' recommendation to use shared decision-making with parents when considering the resuscitation options for their EPI.

Neurodevelopmental impairment in preterm infants with late-onset infection: not only in extremely preterm infants

2014 ◽  
Vol 173 (8) ◽  
pp. 1017-1023 ◽  
Author(s):  
Alexis Chenouard ◽  
Géraldine Gascoin ◽  
Christèle Gras-Le Guen ◽  
Yannis Montcho ◽  
Jean-Christophe Rozé ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Late Onset ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Neurodevelopmental Impairment ◽  
Late Onset Infection

Association between Umbilical Catheters and Neonatal Outcomes in Extremely Preterm Infants

2017 ◽  
Vol 35 (03) ◽  
pp. 233-241
Author(s):  
Mohamed Elboraee ◽  
Jennifer Toye ◽  
Xiang Ye ◽  
Prakesh Shah ◽  
Khalid Aziz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Morbidity ◽  
Neonatal Intensive Care Units ◽  
Design Data ◽  
Major Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Umbilical Catheters ◽  
Multivariable Analyses

Objective The objective of this study was to examine the association between umbilical catheters and a composite outcome of mortality or major neonatal morbidity in extremely preterm infants. Study Design Data were abstracted from the Canadian Neonatal Network database for infants born at <29 weeks' gestational age and admitted to 29 neonatal intensive care units between January 2010 and December 2012. Four groups were identified: those with no umbilical catheters, umbilical venous catheters (UVCs), umbilical artery catheters (UACs), and those with both UVCs and UACs. The outcomes were compared among the groups using univariate and multivariable analyses. Results Of 4,623 eligible infants, 820 (17.7%) had no catheters, 1,032 (22.3%) a UVC only, 120 (2.6%) a UAC only, and 2,651 (57.3%) had both catheters. After adjustment for acuity and other potential confounders, umbilical catheters were associated with higher odds of mortality or any major morbidity (UVC vs. no catheter: adjusted odds ratio [aOR]: 1.47; 95% CI: 1.18–1.85; UAC vs. no catheter: aOR: 1.67; 95% CI: 1.05–2.63; and both UVC + UAC vs. no catheter: aOR: 2.17; 95% CI: 1.79–2.70). Conclusion Most of the infants born at <29 weeks' gestation had UVC and/or UAC placement. The presence of either catheter was associated with mortality or major morbidity, and the association was stronger when both catheters were present.

scholarly journals Late-onset volvulus without malrotation in extremely preterm infants - a case-control-study

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Christoph Maas ◽  
Stefanie Hammer ◽  
Hans-Joachim Kirschner ◽  
Yasemin Yarkin ◽  
Christian F Poets ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Case Control Study ◽  
Late Onset ◽  
Case Control ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Control Study

scholarly journals Neonatal factors related to center variation in the incidence of late-onset circulatory collapse in extremely preterm infants

PLoS ONE ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. e0198518 ◽  
Author(s):  
Yume Suzuki ◽  
Yumi Kono ◽  
Takahiro Hayakawa ◽  
Hironori Shimozawa ◽  
Miyuki Matano ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Late Onset ◽  
Circulatory Collapse ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Trends in sex-specific differences in outcomes in extreme preterms: progress or natural barriers?

2019 ◽  
Vol 105 (2) ◽  
pp. 158-163 ◽  
Author(s):  
Jarred Garfinkle ◽  
Eugene W Yoon ◽  
Ruben Alvaro ◽  
Chuks Nwaesei ◽  
Martine Claveau ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Late Onset ◽  
Major Morbidity ◽  
Adjusted Risk ◽  
Antenatal Steroids ◽  
Adjusted Risk Ratio ◽  
Late Onset Sepsis ◽  
Care Practices ◽  
The Difference ◽  
Biological Differences

ObjectiveTo examine the differences and trends of outcomes of preterm boys and girls born at <29 weeks’ gestation.DesignA retrospective cohort study.SettingData collected by the Canadian Neonatal Network.PatientsNeonates born at <29 weeks’ gestation between January 2007 and December 2016.Main outcome measuresWe examined rate differences in mortality, major morbidities (bronchopulmonary dysplasia, severe brain injury, retinopathy of prematurity, necrotising enterocolitis and late-onset sepsis) and care practices (antenatal steroids, magnesium sulfate, maternal antibiotics, ventilation and surfactant administration) between boys and girls and evaluated trends in these rate differences over the study period. Our primary outcome was a composite of mortality and any one of the five morbidities.ResultsOur study included 8219 boys and 6934 girls with median gestational age of 26 (IQR 25–28) weeks. The composite of death or major morbidity was more common in boys (adjusted risk ratio 1.07, 95% CI 1.05 to 1.10) and remained higher in boys over the study period. The gap between boys and girls for mortality, however, decreased over time: the slope for boys was −0.043 (95% CI −0.071 to −0.015) and for girls was −0.012 (95% CI −0.045 to 0.020) (p=0.04). All other morbidities remained higher in boys. Care practices changed at similar rates between the sexes.ConclusionThe difference between the mortality rates for boys and girls decreased over the study period but the difference between rates of the major morbidities was unchanged. More research is needed to understand biological differences and outcome disparities.

Increased incidence of necrotizing enterocolitis associated with routine administration of Infloran™ in extremely preterm infants

2018 ◽  
Vol 9 (5) ◽  
pp. 683-690 ◽  
Author(s):  
E. Escribano ◽  
C. Zozaya ◽  
R. Madero ◽  
L. Sánchez ◽  
J. van Goudoever ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Late Onset ◽  
Blood Cultures ◽  
Antenatal Steroids ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Routine Administration ◽  
Probiotic Product

We aimed to evaluate the isolation of strains contained in the Infloran™ probiotic preparation in blood cultures and its efficacy in reducing necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in extremely preterm infants. Routine use of probiotics was implemented in 2008. Infants born at <28 weeks gestational age were prospectively followed and compared with historical controls (HC) born between 2005 and 2008. Data on sepsis due to any of the two probiotic strains contained in Infloran and rates of LOS and NEC were analysed. A total of 516 infants were included. During the probiotic period (PC), none of the strains included in the administered probiotic product were isolated from blood cultures. Probiotic administration was associated with an increase in NEC stage II or higher (HC 10/170 [5.9%]; PC 46/346 [13.3%]; P=0.010). Surgical NEC was 12.1% in PC (42/346) versus 5.9% (10/170) in HC (P=0.029). Adjusting for confounders (sex, gestational age, antenatal steroids and human milk) did not change those trends (P=0.019). Overall, clinical LOS and the incidence of staphylococcal sepsis were lower in PC (172/342, 50.3, and 37%, respectively) compared with HC (102/169, 60.3 and 50.9%, respectively) (P=0.038 and P=0.003, respectively). No episodes of sepsis attributable to the probiotic product were recorded. The period of probiotic administration was associated with an increased incidence of NEC after adjusting for neonatal factors, but also with a reduction in the LOS rate.

Temporal Trends of Acute Kidney Injury and Associated Risk Exposures in Extremely Preterm Infants

2021 ◽  
pp. CJN.19301220
Author(s):  
Chih-Chia Chen ◽  
Yung-Chieh Lin ◽  
Shan-Tair Wang ◽  
Chao-Ching Huang ◽  
Keyword(s):  
Serum Creatinine ◽  
Preterm Infants ◽  
Gestational Age ◽  
Temporal Trends ◽  
Content Type ◽  
Very Preterm ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Preterm Group ◽  
Care Practices

Background and objectivesNeonatal AKI in the preterm population is an under-recognized morbidity. Detecting AKI in preterm infants is important for their long-term kidney health. We aimed to examine the yearly trends of incidence and the related morbidities and care practices affecting the occurrence of neonatal AKI in extremely preterm (gestational age <29 weeks) and very preterm (gestational age 29–32 weeks) infants.Design, setting, participants, & measurementsThe trends and the related risk factors and care practices of AKI were examined in the extremely preterm (n=434) and very preterm (n=257) infants who were admitted within 14 days after birth from 2005 to 2018 to the University Hospital and had at least two serum creatinine measurements during hospitalization. We defined AKI as a serum creatinine rise of 0.3 mg/dl or more within 48 hours or a 1.5-fold increase within 7 days.ResultsThe extremely preterm group had a three-fold higher incidence of AKI (30% versus 10%) than the very preterm group. Among preterm infants with AKI, 92% had one episode of AKI, and 45% experienced stage 2 or 3 AKI; the mean duration of AKI was 12±9 days. Across the 14-year period, the crude incidence of AKI declined markedly from 56% to 17% in the extremely preterm group and from 23% to 6% in the very preterm group. After adjustment, a significant decline of AKI incidence was still observed in the extremely preterm group. The declining AKI in the extremely preterm infants was related to the trends of decreasing incidences of neonatal transfer, prolonged aminoglycoside exposure, prophylactic use of nonsteroidal anti-inflammatory drugs, and sepsis.ConclusionsWe observed a declining trend in the incidence of neonatal AKI among extremely preterm infants from 2005 to 2018, which may be related to improvement of care practices.

66 Long-term survival and neurodevelopmental outcomes of very-preterm infants born in Canada between 2009 and 2016

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e46-e47
Author(s):  
M Florencia Ricci ◽  
Prakesh Shah ◽  
Diane Moddemann ◽  
Ruben Alvaro ◽  
Eugene Ng ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Hearing Impairment ◽  
Late Onset ◽  
Cognitive Outcome ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Medicine ◽  
Term Survival ◽  
Extremely Preterm ◽  
Neurodevelopmental Impairment ◽  
Improvement Programs

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Quality improvement programs across Canadian Neonatal Network (CNN) sites have led to increased neonatal survival without major neonatal morbidity among infants born extremely preterm. The next step is to determine if such activities impact longer-term survival and neurodevelopmental outcomes. Objectives This cohort study aimed to compare death or significant neurodevelopmental impairment (sNDI) (Bayley-III scores &lt; 70, severe cerebral palsy, blind, or hearing aided) at 18-24 months corrected age among infants born &lt; 29 weeks’ gestation admitted to CNN sites, between 2 Epochs: 1 (2009-2012) and 2 (2013-2016). Secondary objectives included death or neurodevelopmental impairment (NDI) (Bayley-III &lt; 85, any cerebral palsy, visual or hearing impairment), death, sNDI, NDI, and components of neurodevelopmental impairment. Design/Methods Only sites with ≥ 70% follow-up rates were included. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Pearson Chi-square and Student t-test testing. Adjusted odds ratios with 95% CIs were calculated for outcome change between the 2 Epochs, accounting for patient characteristic differences in the model. Results Study population included 4426 children; Epoch 1: 1895 (43%) and Epoch 2: 2531 (57%). In Epoch 2, more mothers received MgSO4 (56.3% vs. 28.4%; p&lt;0.01), antibiotics (69%vs.65.3%; p 0.01) and delayed cord clamping (37.1% vs. 31.3%; p 0.02), and fewer infants had SNAP-2 (illness severity score) &gt;20 (30.7% vs. 35.2%; p&lt;0.01) or late-onset sepsis (23.3% vs. 26.9%; p 0.01). See Table 1. Conclusion Significant reductions in rate of death or sNDI, and in visual and hearing impairment, were identified between Epoch 2 to Epoch 1. An increase in poor cognitive outcome rates requires further study.

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