Neurodevelopmental Outcomes of Infants Born at &lt;29 Weeks of Gestation Admitted to Canadian Neonatal Intensive Care Units Based on Location of Birth

Amer, Reem; Moddemann, Diane; Seshia, Mary; Alvaro, Ruben; Synnes, Anne; Lee, Kyong-Soon; Lee, Shoo K.; Shah, Prakesh S.; Harrison, Adele; Ting, Joseph; Cieslak, Zenon; Sherlock, Rebecca; Yee, Wendy; Aziz, Khalid; Toye, Jennifer; Fajardo, Carlos; Kalapesi, Zarin; Sankaran, Koravangattu; Daspal, Sibasis; Mukerji, Amit; Da, Orlando; Nwaesei, Chuks; Dunn, Michael; Lemyre, Brigitte; Dow, Kimberly; Pelausa, Ermelinda; Barrington, Keith J.; Drolet, Christine; Piedboeuf, Bruno; Claveau, Martine; Faucher, Daniel; Bertelle, Valérie; Massé, Édith; Canning, Roderick; Makary, Hala; Ojah, Cecil; Monterrosa, Luis; Deshpandey, Akhil; Afifi, Jehier; Kajetanowicz, Andrzej; Pillay, Thevanisha; Sauvé, Reg; Hendson, Leonora; Reichert, Amber; Bodani, Jaya; deCabo, Cecilia; Daboval, Thierry; Lee, David; Ly, Linh; Kelly, Edmond; Helou, Salhab el; Church, Paige; Beltempo, Marc; Levebrve, Francine; Demers, Charlotte; Bélanger, Sylvie; Vincer, Michael; Murphy, Phil

doi:10.1016/j.jpeds.2017.11.038

Cited by 61 publications

(52 citation statements)

References 29 publications

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“…In addition, of the 9 countries with outborn rates available, 7 reported a decrease in outborn neonates in epoch 2, which previous reports showed was associated with decreased mortality. [28][29][30] However, the observed practice changes only partly explains the differences in outcomes rates between and within countries. Socioeconomic circumstances among countries may differ and external economic impacts on national scales also may have contributed to the changes in services available and outcome changes observed.…”

Section: Discussionmentioning

confidence: 99%

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Lui

Lee

Kusuda

et al. 2019

The Journal of Pediatrics

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on behalf of the International Network for Evaluation of Outcomes (iNeo) of neonates Investigators* Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 24 0/7 to 31 6/7 weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. Results For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. Conclusions In most countries, mortality decreased whereas BPD increased for neonates born very preterm.

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Section: Discussionmentioning

confidence: 99%

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Lui

Lee

Kusuda

et al. 2019

The Journal of Pediatrics

Self Cite

186

132

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“…Population-based studies in the USA demonstrate increased mortality among these ‘outborn’ neonates,3–6 with odds of death approximately 55% higher than ‘inborn’ neonates 7. Similar survival disparities have been described in other developed nations,8–15 where outborn status also predicts worse long-term neurodevelopment 9 10. Despite regionalisation of perinatal care in these countries,1 2 approximately 15% of very preterm neonates are outborn6 11 12—perhaps 10 000 neonates each year in USA alone 16…”

Section: Introductionmentioning

confidence: 74%

“…Perinatal characteristics, including maternal comorbid illnesses, complications of pregnancy, precipitous and spontaneous preterm labour and exposure to antenatal steroids, are significantly different between inborn and outborn preterm neonates 5 10–12 14 17. Study design must be sufficient to discern the impact of inborn-outborn status from other potential confounders when analysing patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies have generally relied on data from birth certificates, discharge abstracts and International Classification of Diseases, Ninth Revision, Clinical Modification codes,3–6 which may lack clinically relevant data such as antenatal steroid administration, use of surfactant and disease severity. In addition, previous work has used traditional covariate adjustment in regression models to risk-adjust outcome differences between inborns and outborns 3 5 6 10–13 15. The meta-analysis by Lasswell et al 7 concluded ‘Future research must ensure that adjustment for confounding is both thorough and appropriate to achieve accurate effect estimates.’ Statistical literature suggests that analytical methods should separate the design from the analysis of the primary outcome 18 19.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress

Fang

Mara

Weaver

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo compare the risk of mortality and morbidity between outborn and propensity score-matched inborn extremely preterm neonates.SettingMultiple neonatal intensive care units (NICU) across the USA.PatientsSingleton neonates born at 22–29 weeks’ gestation with no major anomalies who were admitted to an NICU and discharged between 2000 and 2014. Outborn neonates were restricted to those who transferred into an NICU on the day of birth.MethodsThe association between inborn-outborn status and the time-to-event outcomes of in-hospital mortality and necrotising enterocolitis (NEC) were assessed using Cox proportional hazards regression. Logistic regression was used to assess the remaining secondary outcomes: retinopathy of prematurity requiring treatment (tROP), chronic lung disease (CLD), periventricular leucomalacia (PVL) and severe intraventricular haemorrhage (IVH). Since outborn status was not random, we used 1:1 propensity score matching to reduce the imbalance in illness severity.ResultsThere were 59 942 neonates (7991 outborn) included in the study. Outborn neonates had poorer survival than inborns and higher rates of NEC, severe IVH, tROP and PVL. Inborn-outborn disparities in mortality were reduced over the study period. When analysing the matched cohort (6524 matched pairs), outborns were less likely to die in-hospital compared with inborns (HR 0.84, 95% CI 0.77 to 0.91). However, outborns experienced higher rates of NEC (HR 1.14, 95% CI 1.04 to 1.25), severe IVH (OR 1.52, 95% CI 1.38 to 1.68), tROP (OR 1.45, 95% CI 1.25 to 1.69) and CLD (OR 1.12, 95% CI 1.01 to 1.24).ConclusionAdditional research is needed to understand the contributors to increased morbidity for outborn extremely preterm neonates and identify interventions that mitigate this risk.

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“…8 In this volume of The Journal, Amer et al report that outborn infants born preterm at <29 weeks of gestation were more likely to have the composite of death or adverse neurodevelopmental outcomes than those born in NICUs within the Canadian Neonatal Network. 9 Using data from 28 Network centers, the authors studied nearly 3000 infants, of whom 16% were outborn. Similar to previous findings, the rates of death, severe brain injury, and grade III or IV intraventricular hemorrhage were greater in the outborn infants.…”

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confidence: 99%

Potential Impact on Development: More Evidence for Risk-Appropriate Neonatal Care

Stark

Papile

2018

The Journal of Pediatrics

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Neurodevelopmental Outcomes of Infants Born at <29 Weeks of Gestation Admitted to Canadian Neonatal Intensive Care Units Based on Location of Birth

Cited by 61 publications

References 29 publications

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress

Potential Impact on Development: More Evidence for Risk-Appropriate Neonatal Care

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