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18 results on '"Hala Makary"'

1. Association of umbilical cord blood gas values with mortality and severe neurologic injury in preterm neonates29 weeks' gestation: a national cohort study

Author

Prakesh S. Shah, Jon Barrett, Martine Claveau, Zenon Cieslak, Hala Makary, Luis Monterrosa, Rebecca Sherlock, Jie Yang, Sarah D. McDonald, Marc Beltempo, Jaideep Kanungo, Joseph Ting, Ayman Abou Mehrem, Jennifer Toye, Khalid Aziz, Carlos Fajardo, Jaya Bodani, Lannae Strueby, Mary Seshia, Deepak Louis, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Sajit Augustine, Kyong-Soon Lee, Eugene Ng, Brigitte Lemyre, Thierry Daboval, Faiza Khurshid, Victoria Bizgu, Keith Barrington, Anie Lapoint, Guillaume Ethier, Christine Drolet, Bruno Piedboeuf, Marie St-Hilaire, Valerie Bertelle, Edith Masse, Roderick Canning, Cecil Ojah, Julie Emberley, Jehier Afifi, Andrzej Kajetanowicz, Shoo K. Lee, Wendy Whittle, Michelle Morais, Leanne Dahlgren, Darine El-Chaar, Katherine Theriault, Annie Ouellet, Kimberly Butt, Stephen Wood, Amy Metcalfe, Candace O'Quinn, Christy Pylypjuk, Isabelle Boucoiran, Catherine Taillefer, Joan Crane, Haim Abenhaim, Graeme Smith, Karen Wou, Sue Chandra, Jagdeep Ubhi, George Carson, Michael Helewa, Ariadna Grigoriu, Rob Gratton, Cynthia Chan, James Andrews, Nir Melamed, Jason Burrows, Fatima Taboun, Lara Wesson, Erin MacLellan, Hayley Boss, and Vicky Allen

Subjects
Infant, Newborn, Obstetrics and Gynecology, Infant, Gestational Age, Hydrogen-Ion Concentration, Fetal Blood, Umbilical Cord, Cohort Studies, Pregnancy, Lactates, Birth Weight, Humans, Female, Retrospective Studies
Abstract

Umbilical cord arterial and venous blood gas values reflect the acid-base balance status of a newborn at birth. Derangement in these values has been linked to poor neonatal outcomes in term and late preterm neonates; however, the utility of these values in preterm neonates of29 weeks' gestation is unclear.This study aimed to determine the associations of umbilical cord arterial and venous blood gas values with neonatal mortality and severe neurologic injury in extremely preterm neonates and to identify the cutoff values associated with 2.5-fold increases or decreases in the posttest probabilities of outcomes.This was a retrospective cohort study of neonates who were born at 23+0 to 28+6 weeks' gestation between January 1, 2018 and December 31, 2019, and who were admitted to neonatal units in Canada.Various cut-offs of umbilical cord blood gas values and lactate values were studied.The main outcomes were mortality before discharge from the neonatal unit and severe neurologic injury defined as grade 3 or 4 periventricular or intraventricular hemorrhage or periventricular leukomalacia. The outcome rates were calculated for various cutoff values of umbilical cord blood gas parameters and were adjusted for birthweight, gestational age, sex, and multiple births. Likelihood ratios were calculated to derive posttest probabilities.A total of 1040 and 1217 neonates had analyzable umbilical cord arterial and venous blood gas values, respectively. In the cohort, the mean (standard deviation) gestational age was 26.5 (1.5) weeks, the mean birthweight was 936 (215) g, the prevalence of mortality was 10% (105/1040), and the prevalence of severe neurologic injury was 9% (92/1016). An umbilical cord arterial pH of ≤7.1 and base excess of ≤-12 mmol/L were associated with2.5-fold higher posttest probability of mortality, and an umbilical cord arterial or venous lactate value of3 was associated with a 2.5-fold lower posttest probability of mortality. An umbilical cord arterial lactate value of3 was associated with a lower posttest probability of severe neurological injury.In preterm neonates of29 weeks' gestation, low umbilical cord arterial pH and high umbilical cord arterial base excess values were associated with a clinically important increase in the posttest probability of mortality, whereas low umbilical cord arterial or venous lactate values were associated with a decrease in the posttest probability of mortality.

Published
2021

2. Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation

Author

Annie Ouellet, Prakesh S. Shah, Lannae Strueby, James Andrews, Graeme N. Smith, Ermelinda Pelausa, Guillaume Ethier, Lara Wesson, Stephen J. Wood, Candace O’Quinn, Kyong-Soon Lee, Christine Drolet, Amy Metcalfe, Hayley Boss, Khalid Aziz, Zenon Cieslak, Jason Burrows, Jagdeep Ubhi, Michelle Morais, Luis Monterrosa, Anie Lapoint, Hala Makary, Karen Wou, Kimberly Butt, Andrzej Kajetanowicz, Ayman Abou Mehrem, Hemasree Kandraju, Leanne Dahlgren, Ruben Alvaro, Rob Gratton, Orlando da Silva, Sibasis Daspal, Jaya Bodani, Darine El-Chaar, Jaideep Kanungo, Christy Pylypjuk, Brigitte Lemyre, Carlos Fajardo, Marie St-Hilaire, Mohammad Adie, Marc Beltempo, Sue Chandra, Joseph Ting, Michael Helewa, Haim A. Abenhaim, Jehier Afifi, Julie Emberley, Ariadna Grigoriu, George Carson, Katherine Theriault, Faiza Khurshid, Vicky Allen, Bruno Piedboeuf, Fatima Taboun, Shoo K. Lee, Cecil Ojah, Rebecca Sherlock, Edith Masse, Xiang Y. Ye, Thierry Daboval, Eugene Ng, Joan Crane, Mary Seshia, Amit Mukerji, Catherine Taillefer, Isabelle Boucoiran, Erin MacLellan, Jon Dorling, Wendy Whittle, Valerie Bertelle, Nir Melamed, Deepak Louis, Martine Claveau, Jennifer Toye, Keith J. Barrington, and Roderick Canning

Subjects
Canada, medicine.medical_specialty, Indomethacin, Gestational Age, Logistic regression, Antenatal steroid, 03 medical and health sciences, 0302 clinical medicine, Primary outcome, indomethacin, Pregnancy, 030225 pediatrics, Spontaneous Intestinal Perforation, Humans, Medicine, 030212 general & internal medicine, Retrospective Studies, intestinal perforation, business.industry, Obstetrics, steroid, Infant, Newborn, Infant, Retrospective cohort study, infant, 3. Good health, Intestinal Perforation, Brain Injuries, Pediatrics, Perinatology and Child Health, Female, Steroids, Co exposure, business, preterm, Infant, Premature
Abstract

Objective: To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at 7 days before birth) exposures. The co-exposure was prophylactic indomethacin. The primary outcome was SIP. Multivariable logistic regression analysis was used to calculate aORs. Results: Among 4720 eligible infants, 4121 (87%) received antenatal steroids and 1045 (22.1%) received prophylactic indomethacin. Among infants exposed to antenatal steroids, those who received prophylactic indomethacin had higher odds of SIP (aOR 1.61, 95% CI 1.14-2.28) compared with no prophylactic indomethacin. Subgroup analyses revealed recent antenatal steroids exposure with prophylactic indomethacin had higher odds of SIP (aOR 1.67, 95% CI 1.15-2.43), but latent antenatal steroids exposure with prophylactic indomethacin did not (aOR 1.24, 95% CI 0.48-3.21), compared with the respective groups with no prophylactic indomethacin. Among those not exposed to antenatal steroids, mortality was lower among those who received prophylactic indomethacin (aOR 0.45, 95% CI 0.28-0.73) compared with no prophylactic indomethacin. Conclusions: In preterm neonates of

Published
2021

3. Association of timing of birth with mortality among preterm infants born in Canada

Author

Angelo, Rizzolo, Prakesh S, Shah, Valerie, Bertelle, Hala, Makary, Xiang Y, Ye, Haim A, Abenhaim, Bruno, Piedboeuf, Marc, Beltempo, and Jill, Zwicker

Subjects
Canada, Logistic Models, Infant, Extremely Premature, Infant Mortality, Infant, Newborn, Odds Ratio, Humans, Infant, Gestational Age
Abstract

To assess the association between time of birth and mortality among preterm infants.Population-based study of infants born 22-36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality.Among infants 22-27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01-1.29). Among infants 28-32 weeks GA and 33-36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59-0.95; AOR 0.78, 95% CI 0.62-0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28-32 and 33-36 weeks GA decreased or were not statistically significant.Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.

Published
2020

4. Delayed cord clamping in small for gestational age preterm infants

Author

Lara Wesson, Karen Wou, Darine El-Chaar, Jason Burrows, Faiza Khurshid, Erin MacLellan, Kyong-Soon Lee, Roderick Canning, Bruno Piedboeuf, Shoo K. Lee, Vicky Allen, Joan M.G. Crane, Jehier Afifi, Cecil Ojah, Mary Seshia, Isabelle Boucoiran, Fatima Taboun, Khalid Aziz, Marc Beltempo, Graeme N. Smith, Joan M. Crane, Victoria Bizgu, Stephen Wood, Wendy Whittle, Rebecca Sherlock, Luis A. Monterrosa, Ariadna Grigoriu, Orlando da Silva, Annie Ouellet, Rob Gratton, Thierry Daboval, Sue Chandra, James Andrews, Beth Ellen Brown, Andrzej Kajetanowicz, Sajit Augustine, Prakesh S. Shah, Katherine Theriault, Keith J. Barrington, George Carson, Amy Metcalfe, Hayley Boss, Jaideep Kanungo, Jagdeep Ubhi, Joseph Ting, Christy Pylypjuk, Xiang Y. Ye, Luis Monterrosa, Martine Claveau, Ayman Abou Mehrem, Hala Makary, Catherine Taillefer, Leanne Dahlgren, Michelle Morais, Anie Lapoint, Amit Mukerji, Eugene Ng, Brigitte Lemyre, Valerie Bertelle, Michael Helewa, Rebecca L. Sherlock, Candace O’Quinn, Guillaume Ethier, Nir Melamed, Walid El-Naggar, Kimberly Butt, Cynthia Chan, Jaya Bodani, Edith Masse, Marie St-Hilaire, Mohammad Adie, Haim A. Abenhaim, Zenon Cieslak, Ruben Alvaro, Christine Drolet, Julie Emberley, Lannae Strueby, Jennifer Toye, and Deepak Louis

Subjects
Male, medicine.medical_specialty, Blood transfusion, Databases, Factual, medicine.medical_treatment, Intrauterine growth restriction, Gestational Age, Pregnancy, Interquartile range, medicine, Humans, Retrospective Studies, Obstetrics, business.industry, Infant, Newborn, Pregnancy Outcome, Obstetrics and Gynecology, Gestational age, Retrospective cohort study, Odds ratio, medicine.disease, Confidence interval, Treatment Outcome, Infant, Small for Gestational Age, Umbilical Cord Clamping, Small for gestational age, Female, business, Infant, Premature
Abstract

Infants with restricted growth for age are frequently exposed to insufficient placental circulation and are more likely to develop postnatal complications. Delayed cord clamping at birth for these infants requires further exploration.This study aimed to compare the short-term neonatal outcomes of delayed cord clamping with that of early cord clamping in small for gestational age preterm infants and to explore whether the effects of delayed cord clamping in small for gestational age preterm infants are different from that in non-small for gestational age preterm infants.We conducted a national retrospective cohort study, including infants born at33 weeks' gestation and admitted to the Canadian Neonatal Network units between January 2015 and December 2017. Small for gestational age infants (birthweight of10th percentile for gestational age and sex) who received delayed cord clamping ≥30 seconds were compared with those who received early cord clamping. In addition, non-small for gestational age infants who received delayed cord clamping were compared with those who received early cord clamping. The main study outcomes included composite outcome of mortality or major morbidity, neonatal morbidity rate, mortality rate, peak serum bilirubin, and number of blood transfusions. Multivariable logistic and linear regression models with a generalized estimation equation approach were used to account for the clustering of infants within centers.Overall, 9722 infants met the inclusion criteria. Of those infants, 1027 (10.6%) were small for gestational age. The median (interquartile range) gestational age was 31 weeks (range, 28-32 weeks). After adjusting for potential confounders, delayed cord clamping in small for gestational age infants was associated with a reduction in the composite outcome of mortality or major morbidity (adjusted odds ratio, 0.60; 95% confidence interval, 0.42-0.86) compared with early cord clamping. There was no difference between the 2 groups in peak serum bilirubin. Many associated benefits of delayed cord clamping in small for gestational age infants were similar to those in non-small for gestational age infants.Delayed cord clamping in small for gestational age preterm infants was associated with decreased odds of mortality or major morbidity. Many of the benefits of delayed cord clamping in the small for gestational age preterm infants were similar to those identified in the non-small for gestational age preterm infants.

Published
2022

5. 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

6. Neurodevelopmental outcomes of singleton large for gestational age infants29 weeks' gestation: a retrospective cohort study

Author

Orlando da Silva, Victoria Bizgu, Cecilia de Cabo, Kyong-Soon Lee, Bruno Piedboeuf, Shoo K. Lee, Chukwuma G. Nwaesei, Kim-Anh Nguyen, Faiza Khurshid, Anne Synnes, Karen A. Thomas, Valerie Bertelle, Keith J. Barrington, May Khairy, Andrzej Kajetanowicz, Leonora Hendson, Paige Church, Kamran Yusuf, Sajit Augustine, Eugene Ng, Joseph Ting, Martine Claveau, Prashanth Murthy, Véronique Dorval, Prakesh S. Shah, Luis Monterrosa, Phil Murphy, Ayman Abou Mehrem, Edith Masse, Mary Seshia, Julie Emberley, Brigitte Lemyre, Roderick Canning, Edmond Kelly, Hala Makary, Matthew Hicks, Thuy Mai Luu, Amber Reichert, Marc Beltempo, Amit Mukerji, Khalid Aziz, Lannae Strueby, Linh Ly, Jehier Afifi, Cecil Ojah, Jaideep Kanungo, Thierry Daboval, Charlotte Demers, Ermelinda Pelausa, Belal Alshaikh, Sylvie Bélanger, Shabih U. Hasan, Christine Drolet, Jaya Bodani, Alyssa Morin, Deepika Rustogi, Deepak Louis, Jennifer Toye, Ruben Alvaro, and Thevanisha Pillay

Subjects
Pediatrics, medicine.medical_specialty, Canada, Gestational Age, Cerebral palsy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, 030225 pediatrics, medicine, Humans, 030212 general & internal medicine, Retrospective Studies, Appropriate for gestational age, business.industry, Singleton, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Infant, Retrospective cohort study, medicine.disease, Bayley iii, Pediatrics, Perinatology and Child Health, Cohort, Gestation, Female, business
Abstract

OBJECTIVE To compare neurodevelopmental outcomes of large and appropriate for gestational age (LGA, AGA) infants

Published
2020

7. Neonatal Outcomes in Very Preterm Infants With Severe Congenital Heart Defects : An International Cohort Study

Author

Mikael Norman, Stellan Håkansson, Satoshi Kusuda, Maximo Vento, Liisa Lehtonen, Brian Reichman, Brian A. Darlow, Mark Adams, Dirk Bassler, Tetsuya Isayama, Franca Rusconi, Shoo Lee, Kei Lui, Junmin Yang, Prakesh S. Shah, Peter Marshall, Peter Schmidt, Anjali Dhawan, Paul Craven, Koert de Waal, Karen Simmer, Andy Gill, Jane Pillow, Jacqueline Stack, Pita Birch, Lucy Cooke, Dan Casalaz, Jim Holberton, Alice Stewart, Lyn Downe, Michael Stewart, Barbara Bajuk, Andrew Berry, Rod Hunt, Charles Kilburn, Tony De Paoli, Srinivas Bolisetty, Mary Paradisis, Ingrid Rieger, Pieter Koorts, Carl Kuschel, Lex Doyle, Andrew Numa, Hazel Carlisle, Nadia Badawi, Alison Loughran‐Fowlds, Guan Koh, Jonathan Davis, Melissa Luig, Chad Andersen, Georgina Chambers, Nicola Austin, Adrienne Lynn, Brian Darlow, Liza Edmonds, Lindsay Mildenhall, Mariam Buksh, Malcolm Battin, Jutta van den Boom, David Bourchier, Vaughan Richardson, Fiona Dineen, Victor Samuel Rajadurai, Simon Lam, Genevieve Fung, Adele Harrison, Anne Synnes, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Wendy Yee, Khalid Aziz, Jennifer Toye, Carlos Fajardo, Zarin Kalapesi, Koravangattu Sankaran, Sibasis Daspal, Mary Seshia, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Chuks Nwaesei, Kyong‐Soon Lee, Michael Dunn, Brigitte Lemyre, Kimberly Dow, Ermelinda Pelausa, Keith Barrington, Christine Drolet, Bruno Piedboeuf, Martine Claveau, Marc Beltempo, Valerie Bertelle, Edith Masse, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Akhil Deshpandey, Jehier Afifi, Andrzej Kajetanowicz, Shoo K. Lee, Sture Andersson, Outi Tammela, Ulla Sankilampi, Timo Saarela, Eli Heymann, 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, David Kohelet, 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, Corporacio Parc Taulí, Josep Figueras Aloy, Francesc Botet Mussons, Israel Anquela Sanz, Gemma Ginovart Galiana, H. De La Santa, 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 MD, 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, Tampere University, Department of Paediatrics, and Clinical Medicine

Subjects
Heart Defects, Congenital, Male, Pediatrics, medicine.medical_specialty, Epidemiology, Birth weight, Gestational Age, Infant, Premature, Diseases, 030204 cardiovascular system & hematology, 3121 Internal medicine, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Developmental biology, Infant Mortality, cardiac malformation, Medicine, Humans, Hospital Mortality, Original Research, business.industry, Mortality rate, Congenital Heart Disease, Infant, Newborn, Gestational age, Pediatrik, preterm birth, Infant, Retinopathy of prematurity, Odds ratio, medicine.disease, mortality, Bronchopulmonary dysplasia, newborn infant, Infant, Extremely Premature, Necrotizing enterocolitis, Female, Mortality/Survival, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract

Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects ( CHDs ) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights CHDs were defined by International Classification of Diseases, Ninth Revision ( ICD‐9 ) and Tenth ( ICD‐10 ) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios ( ORs ) were calculated. Analyses were stratified by type of CHD , gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score–matched OR , 2.30; 95% CI , 1.61–3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score–matched OR (4.96; 95% CI, 2.11–11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76–20.70) at 31 weeks’ gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.

Published
2020

8. Costs of Neonatal Intensive Care for Canadian Infants with Preterm Birth

Author

Juan D. Rios, Prakesh S. Shah, Marc Beltempo, Deepak Louis, Amit Mukerji, Shahirose Premji, Vibhuti Shah, Shoo K. Lee, Petros Pechlivanoglou, Haim Abenhaim, Jehier Afifi, Ruben Alvaro, James Andrews, Anthony Armson, Francois Audibert, Khalid Aziz, Marilyn Ballantyne, Jon Barrett, Anick Berard, Valerie Bertelle, Lucie Blais, Alan Bocking, Jaya Bodani, Jason Burrows, Kimberly Butt, Roderick Canning, George Carson, Nils Chaillet, Sue Chandra, Paige Church, Zenon Cieslak, Joan Crane, Dianne Creighton, Orlando Da Silva, Thierry Daboval, Leanne Dahlgren, Sibasis Daspal, Cecilia de Cabo, Akhil Deshpandey, Kimberly Dow, Christine Drolet, Michael Dunn, null Salhab el Helou, Darine El-Chaar, Walid El-Naggar, Carlos Fajardo, Robert Gagnon, Rob Gratton, Victor Han, Adele Harrison, Shabih Hasan, Michael Helewa, Matthew Hicks, K.S. Joseph, Andrzej Kajetanowicz, Zarin Kalapesi, May Khairy, Thierry Lacaze-Masmonteil, Kyong-Soon Lee, Brigitte Lemyre, Abhay Lodha, Thuy Mai Luu, Linh Ly, Annette Majnemer, Hala Makary, Isabelle Marc, Edith Masse, Sarah D. McDonald, Doug McMillan, Nir Melamed, Amy Metcalfe, Diane Moddemann, Luis Monterrosa, Michelle Morais, William Mundle, Lynn Murphy, Kellie Murphy, Anne-Monique Nuyt, Chuks Nwaesei, Karel O’Brien, Martin Offringa, Cecil Ojah, Annie Ouellet, Jean-Charles Pasquier, Ermelinda Pelausa, Bruno Piedboeuf, Elodie Portales-Casamar, Pramod Puligandla, Eleanor Pullenayegum, Amber Reichert, Kate Robson, Carol Schneider, Mary Seshia, Rebecca Sherlock, Sandesh Shivananda, Nalini Singhal, Erik Skarsgard, Amanda Skoll, Graeme Smith, Anne Synnes, Katherine Thériault, Joseph Ting, Suzanne Tough, Jennifer Toye, Jagdeep Ubhi, Michael Vincer, Wendy Whittle, Hilary Whyte, Doug Wilson, Stephen Wood, Philip Ye, Wendy Yee, Jill Zwicker, null Jaideep Kanungo, Ayman Abou Mehrem, Koravangattu Sankaran, Mohammad Adie, Faiza Khurshid, Keith Barrington, Anie Lapoint, Guillaume Ethier, Martine Claveau, and Julie Emberley

Subjects
Male, medicine.medical_specialty, Canada, Neonatal intensive care unit, Birth weight, Gestational Age, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Intensive care, Intensive Care Units, Neonatal, Medicine, Birth Weight, Humans, 030212 general & internal medicine, Activity-based costing, Unit cost, health care economics and organizations, Health economics, business.industry, Infant, Newborn, Gestational age, Length of Stay, 3. Good health, Hospitalization, Pediatrics, Perinatology and Child Health, Emergency medicine, Cohort, Intensive Care, Neonatal, Female, business, Algorithms, Infant, Premature
Abstract

To develop and validate an itemized costing algorithm for in-patient neonatal intensive care unit (NICU) costs for infants born prematurely that can be used for quality improvement and health economic analyses.We sourced patient resource use data from the Canadian Neonatal Network database, with records from infants admitted to 30 tertiary NICUs in Canada. We sourced unit cost inputs from Ontario hospitals, schedules of benefits, and administrative sources. Costing estimates were generated by matching patient resource use data to the appropriate unit costs. All cost estimates were in 2017 Canadian dollars and assigned from the perspective of a provincial public payer. Results were validated using previous estimates of inpatient NICU costs and hospital case-cost estimates.We assigned costs to 27 742 infants born prematurely admitted from 2015 to 2017. Mean (SD) gestational age and birth weight of the cohort were 31.8 (3.5) weeks and 1843 (739) g, respectively. The median (IQR) cost of hospitalization before NICU discharge was estimated as $20 184 ($9739-51 314) for all infants; $11 810 ($6410-19 800) for infants born at gestational age of 33-36 weeks; $30 572 ($16 597-$51 857) at gestational age of 29-32 weeks; and $100 440 ($56 858-$159 3867) at gestational age of29 weeks. Cost estimates correlated with length of stay (r = 0.97) and gestational age (r = -0.65). The estimates were consistent with provincial resource estimates and previous estimates from Canada.NICU costs for infants with preterm birth increase as gestation decreases and length of stay increases. Our cost estimates are easily accessible, transparent, and congruent with previous cost estimates.

Published
2020

9. Rates and Determinants of Mother’s Own Milk Feeding in Infants Born Very Preterm

Author

Dinesh Dharel, Nalini Singhal, Christel Wood, Zenon Cieslak, Fabiana Bacchini, Prakesh S. Shah, Xiang Y. Ye, Belal Alshaikh, Haim Abenhaim, Jehier Afifi, Ruben Alvaro, James Andrews, Anthony Armson, Francois Audibert, Khalid Aziz, Marilyn Ballantyne, Jon Barrett, Marc Beltempo, Anick Berard, Valerie Bertelle, Lucie Blais, Alan Bocking, Jaya Bodani, Jason Burrows, Kimberly Butt, Roderick Canning, George Carson, Nils Chaillet, Sue Chandra, Paige Church, Kevin Coughlin, Joan Crane, Dianne Creighton, Orlando Da Silva, Thierry Daboval, Leanne Dahlgren, Sibasis Daspal, Cecilia de Cabo, Akhil Deshpandey, Kimberly Dow, Christine Drolet, Michael Dunn, Salhab el Helou, Darine El-Chaar, Walid El-Naggar, Carlos Fajardo, Jonathan Foster, Robert Gagnon, Rob Gratton, Victor Han, Adele Harrison, Shabih Hasan, Michael Helewa, Matthew Hicks, K.S. Joseph, Andrzej Kajetanowicz, Zarin Kalapesi, May Khairy, Thierry Lacaze-Masmonteil, Kyong-Soon Lee, Brigitte Lemyre, Abhay Lodha, Deepak Louis, Thuy Mai Luu, Linh Ly, Annette Majnemer, Hala Makary, Isabelle Marc, Edith Masse, Sarah D. McDonald, Doug McMillan, Nir Melamed, Amy Metcalfe, Diane Moddemann, Luis Monterrosa, Michelle Morais, Amit Mukerji, William Mundle, Lynn Murphy, Kellie Murphy, Anne-Monique Nuyt, Chuks Nwaesei, Karel O’Brien, Martin Offringa, Cecil Ojah, Annie Ouellet, Jean-Charles Pasquier, Petros Pechlivanoglou, Ermelinda Pelausa, Bruno Piedboeuf, Elodie Portales-Casamar, Shahirose Premji, Pramod Puligandla, Eleanor Pullenayegum, Amber Reichert, Carol Schneider, Mary Seshia, Vibhuti Shah, Rebecca Sherlock, Sandesh Shivananda, Erik Skarsgard, Amanda Skoll, Graeme Smith, Anne Synnes, Katherine Thériault, Joseph Ting, Suzanne Tough, Jennifer Toye, Jagdeep Ubhi, Michael Vincer, Wendy Whittle, Hilary Whyte, Doug Wilson, Stephen Wood, Philip Ye, Wendy Yee, and Jill Zwicker

Subjects
Adult, Canada, medicine.medical_specialty, Canadian Neonatal Network, Population, Mothers, Gestational Age, formula feeding, Breast milk, Pediatrics, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Formula feeding, Intensive Care Units, Neonatal, 030225 pediatrics, medicine, Hospital discharge, Humans, 030212 general & internal medicine, education, education.field_of_study, premature infant [breast milk feeding], Milk, Human, Obstetrics, business.industry, Infant, Newborn, Gestational age, Infant Formula, Patient Discharge, Bottle Feeding, Very preterm, Breast Feeding, Logistic Models, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Cohort, Female, business, Cohort study
Abstract

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).This was a population-based cohort study of infants born at33 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.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 with26 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).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.

Published
2021

10. Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

Author

Mosarrat Qureshi, Prakesh S. Shah, Dalal Abdelgadir, Xiang Y. Ye, Jehier Afifi, Ryan Yuen, Sara Calderon Crossman, Barbara Taylor, Khorshid Mohammad, Bruno Piedboeuf, Khalid Aziz, Marc Beltempo, Jaideep Kanungo, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Ayman Abou Mehrem, Jennifer Toye, Carlos Fajardo, Zarin Kalapesi, Jaya Bodani, Koravangattu Sankaran, Lannae Strueby, Mary Seshia, Deepak Louis, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Mohammad Adie, Kyong-Soon Lee, Eugene Ng, Brigitte Lemyre, Faiza Khurshid, Ermelinda Pelausa, Keith Barrington, Anie Lapoint, Guillaume Ethier, Christine Drolet, Martine Claveau, Valerie Bertelle, Edith Masse, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Julie Emberley, Andrzej Kajetanowicz, and Shoo K. Lee

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Birth weight, Confounding, Gestational age, Retrospective cohort study, medicine.disease, 3. Good health, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, 030225 pediatrics, Intensive care, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, Severity of illness, Medicine, 030212 general & internal medicine, business
Abstract

Objective To evaluate the impact of prophylactic indomethacin on early death ( Study design This was a multicenter, retrospective cohort study of neonates (n = 12 515) born at 236/7 weeks of gestational age, admitted to neonatal intensive care units participating in the Canadian Neonatal Network who received prophylactic indomethacin started within the first 12 hours after birth. Univariate and multivariate analysis compared the composite outcomes of early death or severe neurologic injury and early death or spontaneous intestinal perforation. Results Of 12 515 eligible neonates, 1435 (11.5%) were exposed to prophylactic indomethacin; recipients were of lower gestational age and birth weight and had greater severity of illness (Score of Neonatal Acute Physiology with Perinatal Extension) on admission compared with nonrecipients. After we adjusted for confounders, prophylactic indomethacin was associated with reduced odds of early death or severe neurologic injury and early death or spontaneous intestinal perforation in neonates born at 23-24 weeks of gestational age. However, prophylactic indomethacin was associated with increased odds of early mortality or spontaneous intestinal perforation for neonates born at 26-28 weeks of gestational age. Conclusions Prophylactic indomethacin use was associated with benefit in neonates born at 23-24 weeks of gestational age, but with harm at 26-28 weeks of gestational age. Given the observation of significantly improved survival, a randomized controlled trial is needed to investigate the effect of prophylactic indomethacin in babies born at 23-25 weeks of gestational age.

Published
2021

11. Neonates with a 10-min Apgar score of zero: Outcomes by gestational age

Author

You Jia Zhong, Martine Claveau, Eugene W. Yoon, Khalid Aziz, Nalini Singhal, Prakesh S. Shah, Pia Wintermark, Jaideep Kanungo, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Wendy Yee, Jennifer Toye, Carlos Fajardo, Zarin Kalapesi, Koravangattu Sankaran, Sibasis Daspal, Mary Seshia, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Chuks Nwaesei, Kyong-Soon Lee, Michael Dunn, Brigitte Lemyre, Kimberly Dow, Ermelinda Pelausa, Keith Barrington, Christine Drolet, Bruno Piedboeuf, Marc Beltempo, Valerie Bertelle, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Julie Emberley, Jehier Afifi, Andrzej Kajetanowicz, and Shoo K. Lee

Subjects
Male, medicine.medical_specialty, Resuscitation, Canada, Gestational Age, Infant, Premature, Diseases, 030204 cardiovascular system & hematology, Emergency Nursing, 03 medical and health sciences, 0302 clinical medicine, Matched cohort, Hypothermia, Induced, Intensive Care Units, Neonatal, Heart rate, Infant Mortality, Medicine, Humans, Retrospective Studies, business.industry, Obstetrics, Infant, Newborn, Gestational age, Infant, 030208 emergency & critical care medicine, Prognosis, 3. Good health, Survival Rate, Emergency Medicine, Apgar Score, Apgar score, Female, Cardiology and Cardiovascular Medicine, business, Neonatal resuscitation, Follow-Up Studies
Abstract

Background The current resuscitation guidelines for neonates recommend considering stopping resuscitation efforts if the heart rate remains undetectable after 10 min of adequate resuscitation. However, this recommendation does not take into account the gestational age (GA) of the neonates. We determined the outcomes of neonates with a 10-min Apgar score of zero (Apgar10 = 0) with respect to their GA. Methods In a retrospective matched cohort study, we studied neonates admitted to the Canadian Neonatal Network NICUs between 2010 and 2016 with an Apgar10 = 0. The neonates were divided into 3 subgroups according to their GA: (1) ≥36 weeks’, (2) 320/7–356/7 weeks’, and (3) Results 177 neonates had Apgar10 = 0. Survival to discharge was significantly different between GA groups [≥36 weeks’ 61% vs. 320/7–356/7 weeks’ 58% vs. Conclusion Neonates with Apgar10 = 0 had different outcomes depending on their GA. Less than half of neonates born at

Published
2019

12. Actuarial Survival Based on Gestational Age in Days at Birth for Infants Born at <26 Weeks of Gestation

Author

Prakesh S. Shah, Sanaya Rau, Eugene W. Yoon, Ruben Alvaro, Orlando da Silva, Hala Makary, Martine Claveau, Shoo K. Lee, Jaideep Kanungo, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Ayman Abou Mehrem, Jennifer Toye, Khalid Aziz, Carlos Fajardo, Zarin Kalapesi, Jaya Bodani, Koravangattu Sankaran, Sibasis Daspal, Mary Seshia, Deepak Louis, Amit Mukerji, Orlando Da Silva, Mohammad Adie, Kyong-Soon Lee, Michael Dunn, Brigitte Lemyre, Faiza Khurshid, Ermelinda Pelausa, Keith Barrington, Anie Lapoint, Guillaume Ethier, Christine Drolet, Bruno Piedboeuf, Marc Beltempo, Valerie Bertelle, Edith Masse, Roderick Canning, Cecil Ojah, Luis Monterrosa, Julie Emberley, Jehier Afifi, and Andrzej Kajetanowicz

Subjects
Male, Canada, medicine.medical_specialty, Day of life, Gestational Age, Infant, Premature, Diseases, Actuarial survival, Tertiary Care Centers, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, Intensive Care Units, Neonatal, 030225 pediatrics, Intensive care, Infant Mortality, Birth Weight, Humans, Medicine, 030212 general & internal medicine, Retrospective Studies, business.industry, Obstetrics, Last menstrual period, Infant, Newborn, Infant, Gestational age, Retrospective cohort study, Antenatal ultrasound, 3. Good health, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Intensive Care, Neonatal, Gestation, Female, business, Infant, Premature
Abstract

Objective To provide comprehensive, contemporary information on the actuarial survival of infants born at 22-25 weeks of gestation in Canada. Study design In a retrospective cohort study, we included data from preterm infants of 22-25 weeks of gestation admitted to neonatal intensive care units participating in the Canadian Neonatal Network between 2010 and 2017. Infants with major congenital anomalies were excluded. We calculated gestational age using in vitro fertilization date, antenatal ultrasound dating, last menstrual period, obstetrical estimate, or neonatal estimate (in that order). Infants were followed until either discharge or death. Each day of gestational age was considered a category except for births at 22 weeks, where the first 4 days were grouped into one category and the last 3 days were grouped into another category. For each day of life, an actuarial survival rate was obtained by calculating how many infants survived to discharge out of those who had survived up to that day. Results Of 4335 included infants, 85, 679, 1504, and 2067 were born at 22, 23, 24, and 25 weeks of gestation, respectively. Survival increased from 32% at 22 weeks to 83% at 254−6/7 weeks. Graphs of actuarial survival developed for the first 6 weeks after birth in male and female children indicated a steep increase in survival during the first 7-10 days postnatally. Conclusions Survival increased steadily with postnatal survival and was dependent on gestational age in days and sex of the child.

Published
2020

13. Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes

Author

Nicole Fischer, Amuchou Soraisham, Prakesh S. Shah, Anne Synnes, Yacov Rabi, Nalini Singhal, Joseph Y. Ting, Dianne Creighton, Deborah Dewey, Marilyn Ballantyne, Abhay Lodha, Prakesh S Shah, Jaideep Kanungo, Joseph Ting, Wendy Yee, Jennifer Toye, Carlos Fajardo, Zarin Kalapesi, Koravangattu Sankaran, Sibasis Daspal, Mary Seshia, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Chuks Nwaesei, Kyong-Soon Lee, Michael Dunn, Brigitte Lemyre, Kimberly Dow, Ermelinda Pelausa, Anie Lapoint, Christine Drolet, Bruno Piedboeuf, Martine Claveau, Marc Beltempo, Valerie Bertelle, Edith Masse, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Julie Emberley, Jehier Afifi, Andrzej Kajetanowicz, Shoo K Lee, null Canadian Neonatal Follow-Up Network (CNFUN) Investigators, Thevanisha Pillay, Reg Sauvé, Leonora Hendson, Amber Reichert, Jaya Bodani, Diane Moddemann, Thierry Daboval, David Lee, Kevin Coughlin, Linh Ly, Edmond Kelly, Saroj Saigal, Paige Church, Patricia Riley, Thuy Mai Luu, Francine Lefebvre, Charlotte Demers, Sylvie Bélanger, Michael Vincer, and Phil Murphy

Subjects
Male, Pediatrics, medicine.medical_specialty, Canada, medicine.medical_treatment, education, Motor Disorders, Gestational Age, 030204 cardiovascular system & hematology, Emergency Nursing, Odds, 03 medical and health sciences, 0302 clinical medicine, Corrected Age, Infant Mortality, medicine, Humans, Cardiopulmonary resuscitation, Retrospective Studies, business.industry, Delivery room, Infant, Newborn, Gestational age, Infant, 030208 emergency & critical care medicine, Odds ratio, Cardiopulmonary Resuscitation, 3. Good health, Neurodevelopmental Disorders, Infant, Extremely Premature, Emergency Medicine, Premature Birth, Female, Outcome data, Cardiology and Cardiovascular Medicine, business, Neonatal resuscitation, Infant, Premature, Follow-Up Studies
Abstract

To compare mortality and neurodevelopmental outcomes of extremely low gestational age neonates who received delivery room extensive cardiopulmonary resuscitation (DR-CPR) to those who did not require DR-CPR.Preterm neonates born at29 weeks' gestational age between January 2010 and September 2011 and assessed at Canadian Neonatal Follow-Up Network centers were studied. Neonates who received DR-CPR were compared to those who did not require DR-CPR using univariate and multivariable analyses. The primary outcome was a composite of mortality or any neurodevelopmental impairment at 18 to 24 months corrected age defined as the presence of any one or more of the following: cerebral palsy; Bayley-III cognitive, language, or motor composite scores85 on any one of the components; sensorineural/mixed hearing loss or unilateral or bilateral visual impairment. Secondary outcomes were the individual components of the composite outcomes.Of the 2760 neonates born, 173 were excluded and remaining 2587 eligible neonates were included in our study. Of these 2068 had outcome data (80%) of whom 190 (9.2%) received DR-CPR. DR-CPR was independently associated with mortality or neurodevelopmental impairment (adjusted odds ratio [aOR] 1.76; 95% CI 1.21-2.55) and mortality alone (aOR1.94; 95% CI 1.33-2.83). DR-CPR was also associated with increased odds of motor impairment (aOR 2.03; 95% CI 1.28-3.23).In extremely low gestational age neonates, DR-CPR was associated with higher odds of the composite outcome of mortality or neurodevelopmental impairment, mortality alone, and lower motor scores at 18 to 24 months' corrected age.

Published
2018

14. Central Line-Associated Blood Stream Infections and Non-Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units

Author

Kyong-Soon Lee, Marc Beltempo, Julie Emberley, Keith J. Barrington, Joseph Ting, Michael Dunn, Sibasis Daspal, Kimberly Dow, Jehier Afifi, Cecil Ojah, Rebecca Sherlock, Jaideep Kanungo, Bruno Piedboeuf, Shoo K. Lee, Andrzej Kajetanowicz, Zenon Cieslak, Hala Makary, Prakesh S. Shah, Roderick Canning, Chuks Nwaesei, Orlando da Silva, Amit Mukerji, Christine Drolet, Zarin Kalapesi, Ruben Alvaro, Brigitte Lemyre, Jennifer Toye, Koravangattu Sankaran, Carlos Fajardo, Ermelinda Pelausa, Luis Monterrosa, Wendy Yee, Amy R. Zipursky, Martine Claveau, Valerie Bertelle, Anie Lapoint, Mary Seshia, Eugene W. Yoon, and Edith Masse

Subjects
Male, medicine.medical_specialty, Canada, Catheterization, Central Venous, Neonatal intensive care unit, Bacteremia, Gestational Age, Gram-Positive Bacteria, Tertiary care, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Intensive care, Intensive Care Units, Neonatal, Sepsis, Gram-Negative Bacteria, medicine, Central Venous Catheters, Humans, Meningitis, 030212 general & internal medicine, Retrospective Studies, Central line, Cross Infection, business.industry, Tertiary Healthcare, Incidence (epidemiology), Infant, Newborn, Retrospective cohort study, Infections surveillance, 3. Good health, Catheter-Related Infections, Pediatrics, Perinatology and Child Health, Emergency medicine, Regression Analysis, Female, business, Blood stream
Abstract

To determine if the reported reduction in hospital-acquired infections is due to reduced central line-associated blood stream infections (CLABSI) or non-CLABSIs.A retrospective cohort study design was used to describe the change in organism pattern and incidence of hospital-acquired infections (CLABSIs and non-CLABSIs) in neonates33 weeks of gestation admitted to tertiary neonatal intensive care units in the Canadian Neonatal Network between January 1, 2010, and December 31, 2016. Hospital-acquired infection was diagnosed when a pathogenic organism was isolated from blood or cerebrospinal fluid in a neonate with suspected sepsis. CLABSI was diagnosed when a central venous catheter was present at the time or removed in the 2 days before a hospital-acquired infection diagnosis. Cochran-Armitage and Mann-Kendall trend tests and linear regression models were used for statistical analyses.Of 28 144 eligible neonates from 30 Canadian Neonatal Network neonatal intensive care units, 3306 (11.7%) developed hospital-acquired infections. There was a significant decrease in the rate of hospital-acquired infections (14.2% in 2010 and 9.2% in 2016; P .01), and the rate of both CLABSIs and non-CLABSIs (P .01) over the study period concomitant with a significant decrease in the duration of central line use (P = .01). The rates of meningitis also decreased during the study period (1.2% in 2010 and 0.9% in 2016; P .01). Infections owing to gram-positive cocci significantly decreased, but infections owing to gram-negative organisms remained unchanged.Although there was a significant decrease in CLABSIs and non-CLABSIs, hospital-acquired infections in preterm neonates remained high. Infections owing to gram-negative organisms remained unchanged and are a target for future preventative efforts.

Published
2018

15. Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm

Author

Michael Narvey, Bruno Piedboeuf, Shoo K. Lee, Eugene H. Ng, Andrzej Kajetanowicz, Kyong-Soon Lee, Mireille Guillot, Luis Monterrosa, Edith Masse, Hala Makary, Wissam Shalish, Mary Seshia, Chuks Nwaesei, Martine Claveau, Prakesh S. Shah, Anie Lapoint, Ermelinda Pelausa, Carlos Fajardo, Marc Beltempo, Jennifer Toye, Kimberly Dow, Rebecca Sherlock, Orlando da Silva, Jaideep Kanungo, Valerie Bertelle, Andrea Martel-Bucci, Joseph Ting, Jehier Afifi, Cecil Ojah, Wendy Yee, Pia Wintermark, Roderick Canning, Keith J. Barrington, Michael Dunn, Sibasis Daspal, Ruben Alvaro, Zenon Cieslak, Brigitte Lemyre, Zarin Kalapesi, Amit Mukerji, Koravangattu Sankaran, Christine Drolet, and Julie Emberley

Subjects
Male, Pediatrics, medicine.medical_specialty, Leukomalacia, Periventricular, Birth weight, Ultrasound scan, Clinical Decision-Making, Infant, Premature, Diseases, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, 03 medical and health sciences, Neonatal Screening, 0302 clinical medicine, Risk Factors, Clinical Decision Rules, 030225 pediatrics, Odds Ratio, medicine, Humans, 030212 general & internal medicine, Risk factor, Cerebral Intraventricular Hemorrhage, Retrospective Studies, Ultrasonography, Periventricular leukomalacia, business.industry, Infant, Newborn, Gestational age, Retrospective cohort study, medicine.disease, 3. Good health, Logistic Models, Intraventricular hemorrhage, Pediatrics, Perinatology and Child Health, Gestation, Female, business, Head
Abstract

To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 30This was a retrospective cohort study of infants born at 30The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified).Risk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening.

Published
2019

16. Severe Neurodevelopmental Impairment in Neonates Born Preterm: Impact of Varying Definitions in a Canadian Cohort

Author

Matthew D. Haslam, Sarka Lisonkova, Dianne Creighton, Paige Church, Junmin Yang, Prakesh S. Shah, K.S. Joseph, Anne Synnes, Adele Harrison, Joseph Ting, Zenon Cieslak, Rebecca Sherlock, Wendy Yee, Carlos Fajardo, Khalid Aziz, Jennifer Toye, Zarin Kalapesi, Koravangattu Sankaran, Sibasis Daspal, Molly Seshia, Ruben Alvaro, Amit Mukerji, Orlando Da Silva, Chuks Nwaesei, Kyong-Soon Lee, Michael Dunn, Brigitte Lemyre, Kimberly Dow, Ermelinda Pelausa, Lajos Kovacs, Keith Barrington, Christine Drolet, Bruno Piedboeuf, S. Patricia Riley, Martine Claveau, Daniel Faucher, Valerie Bertelle, Edith Masse, Roderick Canning, Hala Makary, Cecil Ojah, Luis Monterrosa, Wayne Andrews, Akhil Deshpandey, Doug McMillan, Jehier Afifi, Andrzej Kajetanowicz, Shoo K. Lee, Thevanisha Pillay, Reg Sauvé, Leonora Hendson, Amber Reichert, Jaya Bodani, Diane Moddemann, Chukwuma Nwaesei, Thierry Daboval, David Lee, Linh Ly, Edmond Kelly, Salhab el Helou, Francine Lefebvre, Charlotte Demers, Sylvie Bélanger, Michael Vincer, and Phil Murphy

Subjects
Male, Canada, medicine.medical_specialty, Pediatrics, Neonatal intensive care unit, Gestational Age, Infant, Premature, Diseases, macromolecular substances, Rate ratio, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Intensive Care Units, Neonatal, 030225 pediatrics, medicine, Humans, 030212 general & internal medicine, Neonatology, business.industry, Incidence, Incidence (epidemiology), Infant, Newborn, Infant, Gestational age, medicine.disease, 3. Good health, nervous system, Bronchopulmonary dysplasia, Neurodevelopmental Disorders, Pediatrics, Perinatology and Child Health, Cohort, Female, business, Infant, Premature, Follow-Up Studies, Cohort study
Abstract

Objective To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. Study design Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included. The incidence of severe NDI, aORs, and 95% CIs were calculated to express the relationship between risk factors and severe NDI using the definitions with the highest and the lowest incidence rates of severe NDI. Results The incidence of severe NDI ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI 3.37-5.47). The associations between risk factors and severe NDI varied depending on the definition used. Maternal ethnicity, employment status, antenatal corticosteroid treatment, and gestational age were not associated consistently with severe NDI. Although maternal substance use, sex, score of neonatal acute physiology >20, late-onset sepsis, bronchopulmonary dysplasia, and brain injury were consistently associated with severe NDI irrespective of definition, the strength of the associations varied. Conclusions The definition of severe NDI significantly influences the incidence and the associations between risk factors and severe NDI. A standardized definition would facilitate site comparisons and scientific communication.

Published
2018

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

Author

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

Subjects
Male, Risk, Canada, Pediatrics, medicine.medical_specialty, Databases, Factual, Adverse outcomes, Birth weight, Diagnostic Techniques, Neurological, Gestational Age, Infant, Premature, Diseases, Nervous System, Cerebral palsy, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Intensive Care Units, Neonatal, 030225 pediatrics, Intensive care, Infant Mortality, medicine, College education, Birth Weight, Humans, 030212 general & internal medicine, Retrospective Studies, Tertiary Healthcare, business.industry, Cerebral Palsy, Data Collection, Infant, Newborn, Composite outcomes, Infant, medicine.disease, 3. Good health, Perinatal Care, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Apgar Score, Gestation, Small for gestational age, Female, business, Infant, Premature
Abstract

To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs).Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity.Of 2951 eligible infants, 473 (16%) were outborn. Mean birth weight (940 ± 278 g vs 897 + 237 g), rates of treatment with antenatal steroids (53.9% vs 92.9%), birth weight small for gestational age (5.3% vs 9.4%), and maternal college education (43.7% vs 53.9%) differed between outborn and inborn infants, respectively (all P values.01). The median Score for Neonatal Acute Physiology-II (P = .01) and Apgar score at 5 minutes (P .01) were higher in inborn infants. Severe brain injury was more common among outborn infants (25.3% vs 14.7%, P .01). Outborn infants had higher odds of death or severe NDI (aOR 1.7, 95% CI 1.3-2.2), death or overall NDI (aOR 1.6, 95% CI 1.2-2.2), death (aOR 2.1, 95% CI 1.5-3.0), and cerebral palsy (aOR 1.9, 95% CI 1.1-3.3).The composite outcomes of death or neurodevelopmental impairment were significantly higher in outborn compared with inborn infants admitted to Canadian NICUs. Adverse outcomes were mainly attributed to increased mortality and cerebral palsy in outborn neonates.

Published
2018

18. The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth

Author

Daniel Faucher, Michael Dunn, Edith Masse, Ermelinda Pelausa, Sibasis Daspal, Anne Synnes, Zarin Kalapesi, Andrzej Kajetanowicz, Luis Monterrosa, Jennifer Toye, Sandesh Shivananda, Kyong-Soon Lee, Hala Makary, Mary Seshia, Joseph Ting, Zenon Cieslak, Jyotsna Shah, Christine Drolet, Kimberly Dow, Brigitte Lemyre, Keith J. Barrington, Adele Harrison, Carlos Fajardo, Rebecca Sherlock, Koravangattu Sankaran, Orlando da Silva, Valerie Bertelle, Prakesh S. Shah, Jehier Afifi, Cecil Ojah, Roderick Canning, Bruno Piedboeuf, Shoo K. Lee, Nir Melamed, Ruben Alvaro, Chuks Nwaesei, Eugene W. Yoon, Khalid Aziz, Akhil Deshpandey, Wendy Yee, Martine Claveau, and Kellie E. Murphy

Subjects
Male, Pediatrics, medicine.medical_specialty, Twins, Gestational Age, Odds, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Adrenal Cortex Hormones, Enterocolitis, Necrotizing, Pregnancy, 030225 pediatrics, Infant Mortality, Diseases in Twins, Odds Ratio, medicine, Birth Weight, Humans, Retinopathy of Prematurity, Bronchopulmonary Dysplasia, Retrospective Studies, Respiratory Distress Syndrome, Newborn, 030219 obstetrics & reproductive medicine, business.industry, Infant, Newborn, Infant, Obstetrics and Gynecology, Gestational age, Prenatal Care, Retinopathy of prematurity, Retrospective cohort study, Odds ratio, medicine.disease, Confidence interval, Treatment Outcome, Bronchopulmonary dysplasia, Pregnancy, Twin, Premature Birth, Small for gestational age, Female, Morbidity, business, Infant, Premature
Abstract

Background Data regarding the effects of antenatal corticosteroids in twin pregnancies are limited because of the insufficient number of women with twins enrolled in randomized controlled trials on antenatal corticosteroids. Furthermore, the interpretation of available data is limited by the fact that the interval from the administration of antenatal corticosteroids to delivery is greater than 7 days in a large proportion of twins, a factor that has been shown to affect the efficacy of antenatal corticosteroids and has not been controlled for in previous studies. Objective The objective of the study was to compare neonatal mortality and morbidity in preterm twins receiving a complete course of antenatal corticosteroids 1–7 days before birth to those who did not receive antenatal corticosteroids and to compare these outcome effects with those observed in singletons. Study Design We performed a retrospective cohort study using data collected on singleton and twin neonates born between 24 0/7 and 33 6/7 weeks' gestational age and were admitted to tertiary neonatal units in Canada between 2010 and 2014. A comparison of neonatal outcomes between twin neonates who received a complete course of antenatal corticosteroids 1–7 days before birth (n = 1758) and those who did not receive antenatal corticosteroids (n = 758) and between singleton neonates who received a complete course of antenatal corticosteroids 1–7 days before birth (n = 4638) and those did not receive antenatal corticosteroids (n = 2312) was conducted after adjusting for gestational age, sex, hypertension, outborn status, small for gestational age, parity, and cesarean birth. Adjusted odds ratios and 95% confidence intervals for various neonatal outcomes were calculated. Results Administration of a complete course of antenatal corticosteroids within 1–7 days before birth in both twins and singletons was associated with similar reduced odds of neonatal death (for twins adjusted odds ratio 0.42 [95% confidence interval, 0.24–0.76] and for singletons adjusted odds ratios, 0.38 [95% confidence interval, 0.28–0.50]; P = .7 for comparison of twins vs singletons), mechanical ventilation (for twins adjusted odds ratio, 0.47 [95% confidence interval, 0.35–0.63] and for singletons adjusted odds ratio, 0.47 [95% confidence interval, 0.41–0.55]; P = .9), respiratory distress syndrome (for twins adjusted odds ratio, 0.53 [95% confidence interval, 0.40–0.69], and for singletons adjusted odds ratio, 0.54 [95% confidence interval, 0.47–0.62]; P = .9) and severe neurological injury (for twins adjusted odds ratio, 0.50 [95% confidence interval, 0.30–0.83] and for singletons adjusted odds ratio, 0.45 [95% confidence interval, 0.34–0.59]; P = .7). Administration of a complete course of antenatal corticosteroids was not associated with a reduced odds of bronchopulmonary dysplasia, severe retinopathy of prematurity, or necrotizing enterocolitis in both twins and singletons. Conclusion Administration of a complete course of antenatal corticosteroids 1–7 days before birth in twin pregnancies is associated with a clinically significant decrease in neonatal mortality, short-term respiratory morbidity, and severe neurological injury that is similar in magnitude to that observed among singletons.

Published
2016

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