RESUMO
OBJECTIVE: To describe the prevalence of and between-center variations in care practices and clinical outcomes of moderate and late preterm infants (MLPIs) admitted to tertiary Canadian neonatal intensive care units (NICUs). STUDY DESIGN: This was a retrospective cohort study including infants born at 320/7 through 366/7 weeks of gestation and admitted to 25 NICUs participating in the Canadian Neonatal Network between 2015 and 2020. Patient characteristics, process measures represented by care practices, and outcome measures represented by clinical in-hospital and discharge outcomes were reported by gestational age weeks. NICUs were compared using indirect standardization after adjustment for patient characteristics. RESULTS: Among 25â669 infants (17% of MLPIs born in Canada during the study period) included, 45% received deferred cord clamping, 7% had admission hypothermia, 47% received noninvasive respiratory support, 11% received mechanical ventilation, 8% received surfactant, 40% received antibiotics in the first 3 days, 4% did not receive feeding in the first 2 days, and 77% had vascular access. Mortality, early-onset sepsis, late-onset sepsis, or necrotizing enterocolitis occurred in <1% of the study cohort. Median (IQR) length of stay was 14 (9-21) days among infants discharged home from the admission hospital and 5 (3-9) days among infants transferred to community hospitals. Among infants discharged home, 33% were discharged on exclusive breastmilk and 75% on any breastmilk. There were significant variations between NICUs in all process and outcome measures. CONCLUSIONS: Care practices and outcomes of MLPIs varied significantly between Canadian NICUs. Standardization of process and outcome quality measures for this population will enable benchmarking and research, facilitating systemwide improvements.
Assuntos
Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Humanos , Canadá , Recém-Nascido , Estudos Retrospectivos , Feminino , Masculino , Centros de Atenção Terciária , Idade Gestacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Doenças do Prematuro/terapia , Doenças do Prematuro/epidemiologiaRESUMO
OBJECTIVES: To examine rates and determinants of mother's own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN). STUDY DESIGN: This was a population-based cohort study of infants born at <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding. RESULTS: Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32 weeks compared with <26 weeks (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61, 95% CI 3.17-4.12). CONCLUSIONS: Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3 days after birth may be associated with improved MOM feeding rates at discharge.
Assuntos
Alimentação com Mamadeira , Aleitamento Materno , Fórmulas Infantis , Leite Humano , Mães/psicologia , Adulto , Canadá , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Modelos Logísticos , Alta do Paciente , Adulto JovemRESUMO
OBJECTIVE: To report the neurodevelopmental outcome of infants enrolled in a randomized multicenter trial of early inhaled nitric oxide (iNO) in term and near-term neonates with hypoxic respiratory failure and pulmonary hypertension. STUDY DESIGN: Neonates born at > or = 34 weeks gestation who required assisted ventilation and had an oxygenation index > or = 15 and < 25 were randomized to an early iNO group or a control group. A comprehensive neurodevelopmental assessment of survivors was performed at age 18 to 24 months. RESULTS: The trial enrolled 299 infants, of which 266 (89%) survived to age 18 to 24 months (136 in the early iNO group and 130 in the control group). Follow-up evaluations were done on 234 (88%) of surviving infants. There were no differences between the 2 groups in the incidence of neurodevelopmental impairment (early iNO, 27%; control, 25%) and hearing impairment (early iNO, 23%; control, 24%). Mental development index scores were similar in the 2 groups; however, psychomotor developmental index scores were significantly higher in the control group (early iNO, 89 +/- 17.7; control, 93.5 +/- 18.4). CONCLUSIONS: Early iNO therapy for hypoxic respiratory failure in term and near-term infants is not associated with an increase in neurodevelopmental impairment or hearing loss at 18 to 24 months postnatal age.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Recém-Nascido Prematuro , Óxido Nítrico/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Administração por Inalação , Sistema Nervoso Central/crescimento & desenvolvimento , Intervalos de Confiança , Método Duplo-Cego , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Probabilidade , Estudos Prospectivos , Valores de Referência , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Nascimento a Termo , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the changes in oxygen saturation (SpO2) in healthy infants during the first 10 minutes of life. STUDY DESIGN: In this observational study, infants > or = 35 weeks gestation at birth who did not require supplemental oxygen had continuous recordings taken of the preductal SpO2 over the first 10 minutes of life. RESULTS: A total of 115 infants were analyzed. On average, infants delivered by cesarean delivery had a 3% lower SpO2 than infants delivered by vaginal delivery (95% confidence interval [CI] = -5.8 to -0.7; P = .01). Infants born by cesarean delivery also took longer (risk ratio, 1.79) to reach a stable SpO2 > or = 85% (95% CI = 1.02 to 3.14; P = .04). At 5 minutes of age, median SpO2 values (interquartile range) were 87% (80% to 95%) for infants delivered vaginally and 81% (75% to 83%) for those delivered through cesarean section. The median SpO2 did not reach 90% until 8 minutes of age in either group. CONCLUSIONS: The process of transitioning to a normal postnatal oxygen saturation requires more than 5 minutes in healthy newborns breathing room air.