The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

Introduction: Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence. Materials and Methods: Infants born at 24–316 weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO4 (prenatal magnesium sulfate), and NT (normothermic temperature [36.0–37.5°C] at admission) and early death and/or severe brain injury in the study population. Results: Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57–0.88), but not MgSO4 only (aOR, 0.97; 95% CI: 0.81–1.17), NT only (aOR, 0.91; 95% CI: 0.76–1.08), or inborn only (aOR, 0.91; 95% CI: 0.72–1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482). Discussion/Conclusion: More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at <32 weeks gestational age.

Download Full-text

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort

BMJ ◽

10.1136/bmj.i2976 ◽

2016 ◽

pp. i2976 ◽

Cited By ~ 69

Author(s):

Jennifer Zeitlin ◽

Bradley N Manktelow ◽

Aurelie Piedvache ◽

Marina Cuttini ◽

Elaine Boyle ◽

...

Keyword(s):

Preterm Infants ◽

Population Based ◽

Evidence Based ◽

Evidence Based Practices ◽

Very Preterm Infants ◽

Severe Morbidity ◽

Very Preterm

Download Full-text

Faculty Opinions recommendation of Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726487267.793577034 ◽

2020 ◽

Author(s):

Andrew Shennan

Keyword(s):

Preterm Infants ◽

Population Based ◽

Evidence Based ◽

Evidence Based Practices ◽

Very Preterm Infants ◽

Severe Morbidity ◽

Very Preterm

Download Full-text

Behaviour at 2 years of age in very preterm infants (gestational age <32 weeks)

Acta Paediatrica ◽

10.1080/08035350310011551 ◽

2003 ◽

Vol 92 (5) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

GMSJ Stoelhorst ◽

SE Martens ◽

M Rijken ◽

van Zwieten PHT ◽

AH Zwinderman ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Very Preterm Infants ◽

Very Preterm

Download Full-text

Significance of low birthweight for gestational age among very preterm infants

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.1997.tb11976.x ◽

1997 ◽

Vol 104 (6) ◽

pp. 668-673 ◽

Cited By ~ 31

Author(s):

Arsenio Spinillo ◽

Ezio Capuzzo ◽

Gaia Piazzi ◽

Federica Baltaro ◽

Mauro Stronati ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Low Birthweight ◽

Very Preterm Infants ◽

Very Preterm

Download Full-text

67 Are NICUs too busy?

Paediatrics & Child Health ◽

10.1093/pch/pxab061.052 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e47-e48

Author(s):

Marc Beltempo ◽

Robert Platt ◽

Anne-Sophie Julien ◽

Regis Blais ◽

Bertelle Valerie ◽

...

Keyword(s):

Preterm Infants ◽

Patient Outcomes ◽

Gestational Age ◽

Late Onset ◽

Mode Of Delivery ◽

Random Effect ◽

Organizational Factors ◽

Neurological Injury ◽

Very Preterm Infants ◽

Very Preterm

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.

Download Full-text

Pulse Oximetry Values in Very Preterm infants Asymtomatic at 34-36 weeks post menstrual age.

10.22541/au.160726775.54268285/v1 ◽

2020 ◽

Author(s):

Ignacio Oyarzún ◽

Marcela Diaz ◽

Paulina Toso ◽

Alejandra Zamorano ◽

Soledad Montes ◽

...

Keyword(s):

Pulse Oximetry ◽

Preterm Infants ◽

Premature Infants ◽

Gestational Age ◽

Oxygen Therapy ◽

Healthy Children ◽

Multicentric Study ◽

Very Preterm Infants ◽

Very Preterm ◽

Postmenstrual Age

Background: Oxygen supplementation is an important component for preterm infants neonatal care. Pulse oximetry (SpO2) is essential to guide oxygen therapy. Evidence on SpO2 values in premature infants previous to discharge is limited. Objectives: To establish SpO2 values in asymptomatic premature infants at 34, 35, and 36 weeks postmenstrual age (PMA). Methods: Longitudinal, multicentric study. From May 2018 to May 2019 premature infants born ≤32 weeks gestational age, from three level III NICUs in Santiago, Chile (altitude 579mt), were enrolled. Healthy children without current apnea of prematurity were included. Continuous SpO2 was obtained with Masimo-Radical 7/8 (USA), averaging time 2-4 seconds. Results: 101 SpO2 recordings (n = 44, 33 and 24 at 34, 35 and 36 weeks PMA respectively) from 62 infants. Twenty eight (45%) male, median (range) gestational age at birth 30 (26-32) weeks, median (range) birth weight 1480 (785-2700) g. Oximetry variables for total recordings: mean SpO2, median (range) 96.9 (93.3-99.3); minimum SpO2, median (range) 74 (51-89); time of SpO2 <90%, median (range) 2% (0-10.6%); time of SpO2 <80%, median (range) 0.1% (0-1.3%); desaturation event by ≥4% (DI4) ≥ 0 and ≥ 10 seconds per sample hour, median (range) 45.2 (5.2-115) and median (range) 15 (3.5-62.5) respectively; desaturation event <80% (DI80), median (range) 0.58 (0-10.8). We found no differences between SpO2 values at different weeks PMA. Conclusions: We described SpO2 values in very preterm infants, asymptomatic at 34, 35 and 36 weeks PMA. These values could be used as a reference to guide oxygen therapy previous to discharge.

Download Full-text