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1. Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks

Author

Sarah E. Seaton, Elizabeth S. Draper, Mark Adams, Satoshi Kusuda, Stellan Håkansson, Kjell Helenius, Brian Reichman, Liisa Lehtonen, Dirk Bassler, Shoo K. Lee, Maximo Vento, Brian A. Darlow, Franca Rusconi, Marc Beltempo, Tetsuya Isayama, Kei Lui, Mikael Norman, Junmin Yang, Prakesh S. Shah, Neena Modi, Peter Marshall, Peter Schmidt, Anjali Dhawan, Larissa Korostenski, Javeed Travadi Travadi, Mary Sharp, Andy Gill, Jane Pillow, Jacqueline Stack, Pita Birch, Karen Nothdurft, Lucy Cooke, Dan Casalaz, Jim Holberton, Alice Stewart, Lyn Downe, Michael Stewart, Andrew Berry, Rod Hunt, Peter Morris, Tony De Paoli, Srinivas Bolisetty, Mary Paradisis, Mark Greenhalgh, Pieter Koorts, Carl Kuschel, Sue Jacobs, Lex Doyle, John Craven, Andrew Numa, Hazel Carlisle, Nadia Badawi, Himanshu Popat, Guan Koh, Jonathan Davis, Melissa Luig, Bevan Headley, Chad Andersen, Linda Ng, Georgina Chambers, Nicola Austin, Adrienne Lynn, Brian Darlow, Liza Edmonds, Lindsay Mildenhall, Mariam Buksh, Malcolm Battin, Jutta van den Boom, Vaughan Richardson, David Barker, Barbara Hammond, Victor Samuel Rajadurai, Simon Lam, Genevieve Fung, Jaideep Kanungo, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Ayman Abou Mehrem, Jennifer Toye, Khalid Aziz, Carlos Fajardo, Jaya Bodani, Lannae Strueby, Mary Seshia, Deepak Louis, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Mohammad Adie, Kyong-Soon Lee, Eugene Ng, Brigitte Lemyre, Thierry Daboval, Faiza Khurshid, Ermelinda Pelausa, Keith Barrington, Anie Lapoint, Guillaume Ethier, Christine Drolet, Bruno Piedboeuf, Martine Claveau, Marie St-Hilaire, Valerie Bertelle, Edith Masse, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Julie Emberley, Jehier Afifi, Andrzej Kajetanowicz, Marjo Metsäranta, Outi Tammela, Ulla Sankilampi, Timo Saarela, Iris Morag, Shmuel Zangen, Tatyana Smolkin, Francis Mimouni, David Bader, Avi Rothschild, Zipora Strauss, Clari Felszer, Hussam Omari, Smadar Even Tov-Friedman, Benjamin Bar-Oz, Michael Feldman, Nizar Saad, Orna Flidel-Rimon, Meir Weisbrod, Daniel Lubin, Ita Litmanovitz, Amir Kugelman, Eric Shinwell, Gil Klinger, Yousif Nijim, Alona Bin-Nun, Agneta Golan, Dror Mandel, Vered Fleisher-Sheffer, Anat Oron, Lev Bakhrakh, Satoshi Hattori, Masaru Shirai, Toru Ishioka, Toshihiko Mori, Takasuke Amizuka, Toru Huchimukai, Hiroshi Yoshida, Ayako Sasaki, Junichi Shimizu, Toshihiko Nakamura, Mami Maruyama, Hiroshi Matsumoto, Shinichi Hosokawa, Atsuko Taki, Machiko Nakagawa, Kyone Ko, Azusa Uozumi, Setsuko Nakata, Akira Shimazaki, Tatsuya Yoda, Osamu Numata, Hiroaki Imamura, Azusa Kobayashi, Shuko Tokuriki, Yasushi Uchida, Takahiro Arai, Mitsuhiro Ito, Kuniko Ieda, Toshiyuki Ono, Masashi Hayashi, Kanemasa Maki, MieToru Yamakawa, Masahiko Kawai, Noriko Fujii, Kozue Shiomi, Koji Nozaki, Hiroshi Wada, Taho Kim, Yasuyuki Tokunaga, Akihiro Takatera, Toshio Oshima, Hiroshi Sumida, Yae Michinomae, Yoshio Kusumoto, Seiji Yoshimoto, Takeshi Morisawa, Tamaki Ohashi, Yukihiro Takahashi, Moriharu Sugimoto, Noriaki Ono, Shinichiro Miyagawa, Takahiko Saijo, Takashi Yamagami, Kosuke Koyano, Shoko Kobayashi, Takeshi Kanda, Yoshihiro Sakemi, Mikio Aoki, Koichi Iida, Mitsushi Goshi, Yuko Maruyama, Alejandro Avila-Alvarez, José Luis Fernandez-Trisac, Ma Luz Couce Pico, María José Fernández Seara, Andrés Martínez Gutiérrez, Carolina Vizcaíno, Miriam Salvador Iglesias, Honorio Sánchez Zaplana, Belén Fernández Colomer, José Enrique García López, Rafael García Mozo, M. Teresa González Martínez, Ma Dolores Muro Sebastián, Marta Balart Carbonell, Joan Badia Barnusell, Mònica Domingo Puiggròs, Josep Figueras Aloy, Francesc Botet Mussons, Israel Anquela Sanz, Gemma Ginovart Galiana, W. Coroleu, Martin Iriondo, Laura Castells Vilella, Roser Porta, Xavier Demestre, Silvia Martínez Nadal, Cristina de Frutos Martínez, María Jesús López Cuesta, Dolores Esquivel Mora, Joaquín Ortiz Tardío, Isabel Benavente, Almudena Alonso, Ramón Aguilera Olmos, Miguel A. García Cabezas, Ma Dolores Martínez Jiménez, Ma Pilar Jaraba Caballero, Ma Dolores Ordoñez Díaz, Alberto Trujillo Fagundo, Lluis Mayol Canals, Fermín García-Muñoz Rodrigo, Lourdes Urquía Martí, María Fernanda Moreno Galdo, José Antonio Hurtado Suazo, Eduardo Narbona López, José Uberos Fernández, Miguel A. Cortajarena Altuna, Oihana Muga Zuriarrain, David Mora Navarro, María Teresa Domínguez, Ma Yolanda Ruiz del Prado, Inés Esteban Díez, María Teresa Palau Benavides, Santiago Lapeña, Teresa Prada, Eduard Soler Mir, Araceli Corredera Sánchez, Enrique Criado Vega, Náyade del Prado, Cristina Fernández, Lucía Cabanillas Vilaplana, Irene Cuadrado Pérez, Luisa López Gómez, Laura Domingo Comeche, Isabel Llana Martín, Carmen González Armengod, Carmen Muñoz Labián, Ma José Santos Muñoz, Dorotea Blanco Bravo, Vicente Pérez, Ma Dolores Elorza Fernández, Celia Díaz González, Susana Ares Segura, Manuela López Azorín, Ana Belén Jimenez, Tomás Sánchez-Tamayo, Elías Tapia Moreno, María González, José Enrique Sánchez Martínez, José María Lloreda García, Concepción Goñi Orayen, Javier Vilas González, María Suárez Albo, Eva González Colmenero, Elena Pilar Gutiérrez González, Beatriz Vacas del Arco, Josefina Márquez Fernández, Laura Acosta Gordillo, Mercedes Granero Asensio, Carmen Macías Díaz, Mar Albújar, Pedro Fuster Jorge, Sabina Romero, Mónica Rivero Falero, Ana Belén Escobar Izquierdo, Javier Estañ Capell, Ma Isabel Izquierdo Macián, Ma Mar Montejo Vicente, Raquel Izquierdo Caballero, Ma Mercedes Martínez, Aintzane Euba, Amaya Rodríguez Serna, Juan María López de Heredia Goya, Alberto Pérez Legorburu, Ana Gutiérrez Amorós, Víctor Manuel Marugán Isabel, Natalio Hernández González, Segundo Rite Gracia, Ma Purificación Ventura Faci, Ma Pilar Samper Villagrasa, Jiri Kofron, Katarina Strand Brodd, Andreas Odlind, Lars Alberg, Sofia Arwehed, Ola Hafström, Anna Kasemo, Karin Nederman, Lars Åhman, Fredrik Ingemarsson, Henrik Petersson, Pernilla Thurn, Eva Albinsson, Bo Selander, Thomas Abrahamsson, Ingela Heimdahl, Kristbjorg Sveinsdottir, Erik Wejryd, Anna Hedlund, Maria Katarina Söderberg, Lars Navér, Thomas Brune, Jens Bäckström, Johan Robinson, Aijaz Farooqi, Erik Normann, Magnus Fredriksson, Anders Palm, Urban Rosenqvist, Bengt Walde, Cecilia Hagman, Andreas Ohlin, Rein Florell, Agneta Smedsaas-Löfvenberg, Philipp Meyer, Rachel Kusche, Sven Schulzke, Mathias Nelle, Bendicht Wagner, Thomas Riedel, Grégoire Kaczala, Riccardo E. Pfister, Jean-François Tolsa, Matthias Roth, Martin Stocker, Bernhard Laubscher, Andreas Malzacher, John P. Micallef, Lukas Hegi, Romaine Arlettaz, Vera Bernet, Carlo Dani, Patrizio Fiorini, Paolo Ghirri, Barbara Tomasini, Anita Mittal, Jonathan Kefas, Anand Kamalanathan, Michael Grosdenier, Christopher Dewhurst, Andreea Bontea, Delyth Webb, Ross Garr, Ahmed Hassan, Priyadarshan Ambadkar, Mark Dyke, Katharine McDevitt, Glynis Rewitzky, Angela D'Amore, P. Kamath, Paul Settle, Natasha Maddock, Ngozi Edi-Osagie, Christos Zipitis, Carrie Heal, Jacqeline Birch, Abdul Hasib, Aung Soe, Bushra Abdul-Malik, Hamudi Kisat, Vimal Vasu, Savi Sivashankar, Richa Gupta, Chris Rawlingson, Tim Wickham, Marice Theron, Giles Kendall, Aashish Gupta, Narendra Aladangady, Imdad Ali, Neeraj Jain, Khalid Mannan, Vadivelam Murthy, Caroline Sullivan, Shu-Ling Chuang, Tristan Bate, Lidia Tyszcuzk, Geraint Lee, Ozioma Obi, John Chang, Vinay Pai, Charlotte Huddy, Salim Yasin, Richard Nicholl, Poornima Pandey, Jonathan Cusack, Venkatesh Kairamkonda, Dominic Muogbo, Liza Harry, Pinki Surana, Penny Broggio, Tilly Pillay, Sanjeev Deshpande, null Mahadevan, Alison Moore, Porus Bastani, Mehdi Garbash, Mithilesh Lal, Majd Abu-Harb, Alex Allwood, Michael Selter, Paul Munyard, David Bartle, Siba Paul, Graham Whincup, Sanghavi Rekha, Philip Amess, Ben Obi, Peter Reynolds, Indranil Misra, Peter De Halpert, Sanjay Salgia, Rekha Sanghavi, Nicola Paul, Abby Deketelaere, Minesh Khashu, Mark Johnson, Charlotte Groves, Jim Baird, Nick Brennan, Katia Vamvakiti, John McIntyre, Jennifer Holman, Stephen Jones, Alison Pike, Pamela Cairns, Megan Eaton, Karin Schwarz, David Gibson, Lawrence Miall, Dr Krishnamurthy, and Sankara Narayanan

Subjects
Male, medicine.medical_specialty, Birth weight, Standard score, Care provision, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Pregnancy, 030225 pediatrics, Intensive Care Units, Neonatal, Infant Mortality, Medicine, Humans, 030212 general & internal medicine, International network, business.industry, Obstetrics, Extremely preterm, Infant, Newborn, Gestational age, Infant, Length of Stay, medicine.disease, Infant mortality, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Linear Models, Female, Pregnancy, Multiple, business
Abstract

Objective To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). Study design Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. Results Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (−4.8 days less than reference, 95% CI –7.3 to −2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI –12.3 to −11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. Conclusions We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.

Published
2020

2. Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm

Author

Mikael Norman, Anne Synnes, Toshihiko Mori, Mitsuhiro Ito, David Kohelet, Hiroshi Matsumoto, Luis Monterrosa, Philipp Meyer, Akhil Deshpandey, Pernilla Thurn, Hiroaki Imamura, Edith Masse, Yuko Maruyama, Toru Ishioka, Satoshi Hattori, Ola Hafström, Wendy Yee, Koravangattu Sankaran, Rachel Kusche, Jehier Afifi, Zipora Strauss, Shmuel Zangen, Takeshi Kanda, Mie Toru Yamakawa, Takashi Yamagami, Sven M. Schulzke, Daniel Lubin, Gil Klinger, Mark Raymond Adams, Maria Katarina Söderberg, Fredrik Ingemarsson, Jennifer Toye, Yukihiro Takahashi, Junichi Shimizu, Michael Feldman, Vera Bernet, Marc Beltempo, Adele Harrison, Joseph Ting, Takeshi Morisawa, Kimberly Dow, Atsuko Taki, Meir Weisbrod, Prakesh S. Shah, Keith J. Barrington, Brian Reichman, Ulla Sankilampi, Benjamin Bar-Oz, Mary Seshia, John P. Micallef, Lev Bakhrakh, Hussam Omari, Liisa Lehtonen, Amit Mukerji, Kozue Shiomi, Bernhard Laubscher, Mikio Aoki, Hiroshi Wada, Cecil Ojah, Dror Mandel, Martin Stocker, Ingela Heimdahl, Toshio Oshima, Bo Selander, Rebecca Sherlock, Yousif Nijim, Ita Litmanovitz, Yoshihiro Sakemi, Yoshio Kusumoto, Henrik Petersson, Alona Bin-Nun, Christine Drolet, Shoko Kobayashi, Shinichiro Miyagawa, Kyong-Soon Lee, Urban Rosenqvist, Takasuke Amizuka, Jean-François Tolsa, Hiroshi Yoshida, Martine Claveau, Andreas Malzacher, Akihiro Takatera, Hiroshi Sumida, Agneta Golan, Jens Bäckström, Thomas Riedel, Rein Florell, Masahiko Kawai, Thomas Brune, Osamu Numata, Lars Åhman, Stellan Håkansson, Outi Tammela, Thomas Abrahamsson, Brigitte Lemyre, Michael Dunn, Clari Felszer, Shuko Tokuriki, Valerie Bertelle, Cecilia Hagman, Takahiko Saijo, Eli Heymann, Akira Shimazaki, Andreas Odlind, Sibasis Daspal, Kosuke Koyano, Roderick Canning, Kjell Helenius, Machiko Nakagawa, Yasushi Uchida, Tamaki Ohashi, Kanemasa Maki, Carlos Fajardo, Orlando da Silva, Matthias Roth, Romaine Arlettaz, Yasuyuki Tokunaga, Toshihiko Nakamura, Azusa Uozumi, Azusa Kobayashi, Avi Rothschild, Karin Nederman, Chuks Nwaesei, Anna Hedlund, Setsuko Nakata, Andreas Ohlin, Katarina Strand Brodd, Erik Normann, Amir Kugelman, Bengt Walde, Dirk Bassler, Tatyana Smolkin, Bruno Piedboeuf, Ermelinda Pelausa, Shoo K. Lee, Noriko Fujii, Orna Flidel-Rimon, Hala Makary, Jiri Kofron, Aijaz Farooqi, Taho Kim, Lars Navér, Khalid Aziz, Toru Huchimukai, Vered Fleisher-Sheffer, Tatsuya Yoda, Agneta Smedsaas Löfvenberg, Tetsuya Isayama, Noriaki Ono, Eva Albinsson, Ruben Alvaro, Kristbjorg Sveinsdottir, Anna Kasemo, Grégoire Kaczala, Junmin Yang, Kyone Ko, Zenon Cieslak, Timo Saarela, Sofia Arwehed, Bendicht Peter Wagner, Mami Maruyama, Eric S. Shinwell, Lars Alberg, Mitsushi Goshi, Zarin Kalapesi, Amish Jain, Moriharu Sugimoto, Mathias Nelle, Koji Nozaki, Kuniko Ieda, Shinichi Hosokawa, Smadar Even Tov-Friedman, Masashi Hayashi, Magnus Fredriksson, Lukas Hegi, Nizar Saad, Seiji Yoshimoto, Francis B. Mimouni, David Bader, Yae Michinomae, Johan Robinson, Erik Wejryd, Toshiyuki Ono, Sture Andersson, Satoshi Kusuda, Ayako Sasaki, Takahiro Arai, Koichi Iida, Masaru Shirai, Andrzej Kajetanowicz, Riccardo Pfister, Anders Palm, and Pfister, Riccardo

Subjects
Male, Pediatrics, Neonatal intensive care unit, health care facilities, manpower, and services, Indomethacin, Anti-Inflammatory Agents, Ibuprofen, Ibuprofen/therapeutic use, Cohort Studies, 0302 clinical medicine, Japan, Periventricular/epidemiology, Neonatal, Ductus arteriosus, 030212 general & internal medicine, Israel, Ductus Arteriosus, Patent, ddc:618, Anti-Inflammatory Agents, Non-Steroidal, Composite outcomes, 3. Good health, Japan/epidemiology, Europe, Intensive Care Units, medicine.anatomical_structure, Echocardiography, Infant, Extremely Premature, Cohort, cardiovascular system, Necrotizing/epidemiology, Gestation, Female, Cohort study, Adult, Non-Steroidal/therapeutic use, Canada, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Leukomalacia, Periventricular, Birth weight, education, Canada/epidemiology, Extremely Premature, Europe/epidemiology, 03 medical and health sciences, Indomethacin/therapeutic use, Enterocolitis, Necrotizing, Intensive Care Units, Neonatal, 030225 pediatrics, medicine, Humans, cardiovascular diseases, Israel/epidemiology, Cerebral Intraventricular Hemorrhage, Retrospective Studies, Cerebral Intraventricular Hemorrhage/epidemiology, Cardiovascular Surgical Procedures/statistics & numerical data, Enterocolitis, business.industry, Cardiovascular Surgical Procedures, Extremely preterm, Infant, Newborn, Infant, Ductus Arteriosus, Newborn, Pediatrics, Perinatology and Child Health, Linear Models, Patent/diagnostic imaging/epidemiology/therapy, business, Leukomalacia
Abstract

To assess associations between neonatal intensive care unit (NICU)-level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes.This cohort study included infants born at 24-28 weeks of gestation and birth weight1500 g in 2007-2015 in NICUs caring for ≥100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio.From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis.Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes.

Published
2020
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