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
OBJECTIVE: To quantify site-specific costs and their association with survival without major morbidity (SWMM) in Canada for neonates <28 weeks of gestation admitted to large tertiary neonatal intensive care units. METHODS: We conducted a retrospective analysis of infants born at <28 weeks of gestation and admitted to Canadian Neonatal Network sites from 2010 through 2021. Sites that cared for at least 50 eligible infants by gestational age in weeks over the study period were included. Using a validated costing algorithm that assessed physician, nursing, respiratory therapy, diagnostic imaging, transfusions, procedural, medication, and certain indirect costs, we calculated site and resource-specific costs in 2017 Canadian dollars (CAD) and evaluated their relationship with SWMM. RESULTS: Seven sites with 8180 (range 841-1605) eligible neonates with a mean (SD) gestation of 25.4 [1.3] weeks were included. Survival to discharge or transfer was 85.3% with a mean (SD) length of stay of 75 (46) days. The mean (SD) total and daily costs per neonate varied between $94â992 ($60â283) and $174â438 ($130â501) CAD and $1833 ($916) to $2307 ($1281) CAD, respectively. Between sites, there was no relationship between costs and SWMM. CONCLUSIONS: There was marked variation in costs and SWMM between sites in Canada with universal health care. The lack of concordance between both outcomes and costs among sites may provide possibilities for outcomes improvement and cost containment.
Assuntos
Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal , Recém-Nascido , Lactente , Humanos , Estudos Retrospectivos , Canadá , Idade GestacionalRESUMO
OBJECTIVE: To compare neonatal and early-childhood outcomes of twins and singletons born preterm and explore the association of chorionicity with outcomes. STUDY DESIGN: This was a national retrospective cohort study of singleton and twin infants admitted at 230/7-286/7 weeks to level III neonatal intensive care units in Canada (2010-2020). The primary neonatal outcome was a composite of neonatal death or severe neonatal morbidities. The primary early-childhood outcome was a composite of death or significant neurodevelopmental impairment. RESULTS: The study cohort included 3554 twin and 12â815 singleton infants. Twin infants born at 230/7-256/7 weeks had a greater risk of the composite neonatal outcome (adjusted risk ratio 1.04, 95% CI 1.01-1.07). However, these differences were limited to the subgroups of same-sex and monochorionic twin pregnancies. Twin infants of 230/7-256/7 weeks were also at an increased risk of the composite early-childhood outcome (adjusted risk ratio 1.22, 95% CI 1.09-1.37). Twin infants of 260/7-286/7 weeks were not at an increased risk of adverse neonatal outcomes or the composite early-childhood outcome compared with singleton infants. CONCLUSIONS: Among infants born at 230/7-256/7 weeks, twins have a greater risk of adverse neonatal outcomes and the composite early-childhood outcome than singleton infants. However, the increased risk of adverse neonatal outcomes is mostly limited to monochorionic twins and may thus be driven by complications related to monochorionic placentation.