The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families

Abstract

P reterm birth, defined as birth occurring before 37 weeks' gestation, occurs in about 8% of pregnancies in Canada 1 and has a life-long impact on babies, their families and society. As the leading cause of infant death, cerebral palsy and disability, preterm birth is estimated to cost the Canadian health care system over $8 billion per year.2 Previous studies by our group showed that, by applying collaborative, integrated quality improvement via networking, the incidence of major neonatal morbidity decreased by 20%-50% in infants less than 29 weeks of gestational age. [3][4][5] Outcome improvements to date have used data platforms limited to neonatal and neonatal follow-up research 6,7 despite mounting evidence that events before and during pregnancy can have life-long implications for the child. 7,8 Furthermore, our platforms were missing data regarding family integration into preterm birth care, which can positively affect neonatal outcomes. 9 The Canadian Preterm Birth Network (CPTBN), described in this protocol, is funded by the Canadian Institutes of Health Research and aims to expand our existing neonatal platforms to develop a pan-Canadian network consisting of a team with expertise in maternal-fetal medicine, obstetrics, neonatology, The Canadian Preterm Birth Network: a study protocol for improving outcomes for preterm infants and their families 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 r...

Combination of histochemical analyses and micro-MRI reveals regional changes of the murine cervix in preparation for labor

“…Premature opening of the cervix has been implicated in preterm birth (PTB), the delivery of a neonate prior to 37 weeks of gestation 4 , 5 . PTB affects 10.6% of pregnancies worldwide causing significant infant mortality and morbidities, and rates are continuing to increase 6 – 8 . Current methods to predict PTB are inadequate, which is due to the multifactorial etiology of this disease and significant gaps in our understanding of the physiological, biochemical and structural changes in the reproductive tract that lead to PTB.…”

Maternal Lifestyle and Behavioral Factors Affect Risk of Spontaneous Preterm Birth

“…Many babies born preterm suffer from health problems and lifelong disability. This greatly affects individuals, families, society and costs with perinatal health care, lifelong disability, and medical problems [5]. Cnattingius et al (2013) who mentioned that hereditary qualities, life factors, (for example, diet, physical activity), and psychological variables considered hazard factors [6].…”

Is Cerebral Palsy Changing in High Resource Settings? Data From the Quebec Cerebral Palsy Registry

“…5 Identification of temporal trends may be a preliminary indicator of the success of recent neuroprotective strategies designed to reduce neurologic morbidity and to help identify areas requiring future improvement to prevent CP and mitigate eventual morbidity. The objectives of this study were to (1) describe the profile of children with CP in Quebec and (2) identify temporal variation in the profile of CP risk factors, functional outcomes, and comorbidities.…”

“…Advances in prenatal and perinatal practices have led to improved maternal care, decreased birth complications, and increased survival of preterm infants. 1,2 This resulted in a shift in focus in the late 1990s and early 2000s toward the improvement of outcomes for these children. Intravenous administration of magnesium sulfate, improved management of cardiorespiratory status, decreased use of antenatal corticosteroids, and therapeutic hypothermia for asphyxiated term infants, are among the strategies utilized to reduce morbidity in survivors.…”

“…Intravenous administration of magnesium sulfate, improved management of cardiorespiratory status, decreased use of antenatal corticosteroids, and therapeutic hypothermia for asphyxiated term infants, are among the strategies utilized to reduce morbidity in survivors. 1,2 Furthermore, the risk of cerebral palsy (CP) in children born from in vitro fertilization (attributed mainly to low birth weight, multifetal pregnancy, and prematurity, etc) has been mitigated in Canada with the acceptance of practices to reduce the number of embryos transferred and implanted in fertility treatments. 3,4 The Australian Cerebral Palsy Register Group showed a decline in rates of CP in all gestational age groups from the early 1990s and phenotypes, with the greatest decreases observed in nonindependently ambulant (Gross Motor Function Classification System levels III and V), bilateral spastic CP (diplegic, triplegic, quadriplegic), epilepsy, and intellectual impairment.…”