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1. Dwell time and risk of central-line-associated bloodstream infection in neonates

Author

Bowen, J., Bajuk, B., Sedgley, S., Carlisle, H., Kent, A., Smith, J., Craven, P., Cruden, L., Argomand, A., Rieger, I., Malcolm, G., Lutz, T., Reid, S., Stack, J., Callander, I., Medlin, K., Marcin, K., Shingde, V., Chin, M.F., Bonzer, K., Badawi, N., Halliday, R., Karskens, C., Paradisis, M., Kluckow, M., Jacobs, C., Numa, A., Williams, G., Young, J., Luig, M., Baird, J., Lui, K., Oei, J.-L., Cameron, D., Sanderson, E., Yeo, K.T., Wang, A.Y., and Bolisetty, S.

Published
2017
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3. The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities

Author

Shah, PS, Lui, K, Reichman, B, Norman, M, Kusuda, S, Lehtonen, L, Adams, M, Vento, M, Darlow, BA, Modi, N, Rusconi, F, Hakansson, S, San Feliciano, L, Helenius, KK, Bassler, D, Hirano, S, Lee, SK, Marshall, P, Schmidt, P, Dhawan, A, Craven, P, De Waal, K, Simmer, K, Gill, A, Pillow, J, Stack, J, Birch, P, Cooke, L, Casalaz, D, Holberton, J, Stewart, A, Downe, L, Stewart, M, Bajuk, B, Berry, A, Hunt, R, Kilburn, C, De Paoli, T, Bolisetty, S, Paradisis, M, Rieger, I, Koorts, P, Kuschel, C, Numa, A, Carlisle, H, Badawi, N, Loughran-Fowlds, A, Koh, G, Davis, J, Luig, M, Andersen, C, Chambers, G, Austin, N, Lynn, A, Darlow, B, Edmonds, L, Mildenhall, L, Buksh, M, Battin, M, Van den Boom, J, Bourchier, D, Richardson, V, Dineen, F, Rajadurai, VS, Fung, G, Harrison, A, Synnes, A, Ting, J, Cieslak, Z, Sherlock, R, Yee, W, Aziz, K, Toye, J, Fajardo, C, Kalapesi, Z, Sankaran, K, Daspal, S, Seshia, M, Alvaro, R, Mukerji, A, Da Silva, O, Nwaesei, C, Lee, K-S, Dunn, M, Lemyre, B, Dow, K, Pelausa, E, Barrington, K, Drolet, C, Piedboeuf, B, Claveau, M, Beltempo, M, Bertelle, V, Masse, E, Canning, R, Mabry, H, Ojah, C, Monterrosa, L, Deshpandey, A, Afifi, J, Kajetanowicz, A, Andersson, S, Tammela, O, Sankilampi, U, Saarela, T, Prazad, P, Noguchi, A, McWan, K, Button, B, Stratton, W, Hamvus, A, Raghaven, A, Derrick, M, Hadley, R, Covert, R, Lablanc, O, Weiss, M, Bell, A, Shareef, M, Silvestri, J, Heymann, E, Zangen, S, Smolkin, T, Mimouni, F, Bader, D, Rothschild, A, Strauss, Z, Felszer, C, Oman, H, Toy-Friedman, SE, Bar-Oz, B, Feldman, M, Saad, N, Flidel-Rimon, O, Weisbrod, M, Lubin, D, Litmanovitz, I, Kngelman, A, Shinwell, E, Klinger, G, Nijim, Y, Bin-Nun, A, Golan, A, Mandel, D, Fleisher-Sheffer, V, Kohelet, D, Bakhrakh, L, Hattori, S, Shirai, M, Ishioka, T, Mori, T, Amiznka, T, Huchimukai, T, Yoshida, H, Sasaki, A, Shimizu, J, Nakamura, T, Maruyama, M, Matsumoto, H, Hosokawa, S, Taki, A, Nakagawa, M, Ko, K, Uozumi, A, Nakata, S, Shimazaki, A, Yoda, T, Numata, O, Imamura, H, Kobayashi, A, Tokuriki, S, Uchida, Y, Arai, T, Ito, M, Ieda, K, Ono, T, Hayashi, M, Maki, K, Yamakawa, M, Kawai, M, Fujii, N, Shiomi, K, Nozaki, K, Wada, H, Kim, T, Tokunaga, Y, Takatera, A, Oshima, T, Sumida, H, Michinomae, Y, Knsumoto, Y, Yoshimoto, S, Morisawa, T, Ohashi, T, Takahashi, Y, Sugimoto, M, Ono, N, Miyagawa, S, Saijo, T, Yamagami, T, Koyano, K, Kobayashi, S, Kanda, T, Sakemi, Y, Aoki, M, Iida, K, Goshi, M, Maruyama, Y, Avila-Alvarez, A, Luis Fernandez-Trisac, J, Couce Pico, ML, Fernandez Seara, MJ, Martinez Gutierrez, A, Vizcaino, C, Salvador Iglesias, M, Sanchez Zaplana, H, Fernandez Colomer, B, Garcia Lopez, JE, Garcia Mozo, R, Gonzalez Martinez, MT, Muro Sebastian, MD, Balart Carbonell, M, Badia Bamnsell, J, Domingo Puiggros, M, Figueras Aloy, J, Botet Mussons, F, Anquela Sanz, I, Ginovart Galiana, G, Coroleu, W, Iriondo, M, Vilella, LC, Porta, R, Demestre, X, Martinez Nadal, S, De Frutos Martinez, C, Lopez Cuesta, MJ, Esquivel Mora, D, Ortiz Tardio, J, Benavente, I, Alonso, A, Aguilera Olmos, R, Garcia Cabezas, MA, Martinez Jimenez, MD, Jaraba Caballero, MF, Ordofiez Diaz, MD, Fagundo, AT, Canals, LM, Garcia-Munoz Rodrigo, F, Urquia Marti, L, Moreno Galdo, MF, Hurtado Suazo, JA, Narbona Lopez, E, Uberos Fernandez, J, Cortajarena Altana, MA, Mora Navarro, D, Teresa Dominguez, M, Ruiz del Prado, MY, Esteban Diez, I, Palau Benavides, MT, Lapena, S, Prada, T, Soler Mir, E, Corredera Sanchez, A, Criado Vega, E, Del Prado, N, Fernandez, C, Cabanillas Vilaplana, L, Cuadrado Perez, I, Lopez Gomez, L, Domingo Comeche, L, Llana Martin, I, Gonzalez Armengod, C, Munoz Labian, C, Santos Munoz, MJ, Blanco Bravo, D, Perez, V, Elorza Fernandez, MD, Diaz Gonzalez, C, Ares Segura, S, Lopez Azorin, M, Belen Jimenez, A, Sanchez-Tamayo, T, Tapia Moreno, E, Gonzalez, M, Sanchez Martinez, JE, Lloreda Garcia, JM, Goni Orayen, C, Vilas Gonzalez, J, Suarez Albo, M, Gonzalez Colmenero, E, Gutierrez Gonzalez, EP, Vacas del Arco, B, Marquez Fernandez, J, Acosta Gordillo, L, Granero Asensio, M, Macias Diaz, C, Albujar, M, Fuster Jorge, P, Romero, S, Rivero Falero, M, Escobar Izquierdo, AB, Estan Capell, J, Izquierdo Macian, MI, Montejo Vicente, MM, Izquierdo Caballero, R, Mercedes Martinez, M, Euba, A, Rodriguez Serna, A, De Heredia Goya, JML, Perez Legorburu, A, Gutierrez Amoros, A, Marugan Isabel, VM, Hernandez Gonzalez, N, Rite Gracia, S, Ventura Faci, MP, Samper Villagrasa, MP, Kofron, J, Brodd, KS, Odlind, A, Alberg, L, Arwehed, S, Hafstrom, O, Kasemo, A, Nederman, K, Ahman, L, Ingemarsson, F, Petersson, H, Thum, P, Albinsson, E, Selander, B, Abrahamsson, T, Heimdahl, I, Sveinsdottir, K, Wejryd, E, Hedlund, A, Soderberg, MK, Hallberg, B, Brune, T, Backstrom, J, Robinson, J, Farooqi, A, Normann, E, Fredriksson, M, Palm, A, Rosenqvist, U, Hagman, C, Ohlin, A, Floral, R, Smedsaas-Lofvenberg, A, Meyer, P, Anderegg, C, Schulzke, S, Nelle, M, Wagner, B, Riedel, T, Kaczala, G, Walde, B, Pfister, RE, Tolsa, J-F, Roth, M, Stocker, M, Laubscher, B, Malzacher, A, Micallef, JP, Hegi, L, Arlettaz, R, Bernet, V, Dani, C, Fiorini, P, Boldrini, A, Tomasini, B, Mittal, A, Kefas, J, Kamalanathan, A, Jayachandran, Yoxall, B, McBride, T, Webb, D, Garr, R, Hassan, A, Ambadkar, P, Dyke, M, McDevitt, K, Rewitzky, G, D'Amore, A, Panasa, N, Settle, P, Maddock, N, Edi-Osagie, N, Zipitis, C, Heal, C, Birch, J, Hasib, A, Soe, A, Kumar, N, Kisat, H, Vasu, V, Lama, M, Gupta, R, Rawlingson, C, Wickham, T, Theron, M, Kendall, G, Gupta, A, Aladangady, N, Ali, I, Alsford, L, Lopez, W, Murthy, V, Sullivan, C, Thomas, M, Bate, T, Godambe, S, Watts, T, Kuna, J, Chang, J, Pai, V, Huddy, C, Yasin, S, Nicholl, R, Pandey, P, Kairamkonda, V, Muogbo, D, Harry, L, Simmons, P, Nycyk, J, Gallagher, A, Pillay, T, Deshpande, S, Mahadevan, Moore, A, Clark, S, Garbash, M, Lal, M, Abu-Harb, M, Allwood, A, Selter, M, Munyard, P, Bartle, D, Paul, S, Whincup, G, Mallik, A, Amess, P, Godden, C, Reynolds, P, Misra, I, De Halpert, P, Salgia, S, Sanghavi, R, Wigfield, R, Deketelaere, A, Khashu, M, Hall, M, Groves, C, Brown, N, Brennan, N, Vamvakiti, K, McIntyre, J, Pirie, S, Jones, S, Mannix, P, Cairns, P, Eaton, M, Schwarz, K, Gibson, D, Miall, L, Krishnamurthy, University of Zurich, Shah, Prakesh S, Canadian Institutes of Health Research (CIHR), and Neonid NPO

Subjects
medicine.medical_specialty, NEW-ZEALAND, Population, 610 Medicine & health, RETINOPATHY, Review Article, Audit, Pediatrics, outcomes research, MORBIDITY, Nursing, neonatal intensive care, Health care, medicine, LOW-BIRTH-WEIGHT, 2735 Pediatrics, Perinatology and Child Health, education, education.field_of_study, Science & Technology, EXTREMELY PRETERM INFANTS, business.industry, MORTALITY, Public health, Health services research, Preterm infants, Capacity building, BRONCHOPULMONARY DYSPLASIA, Benchmarking, 10027 Clinic for Neonatology, INTENSIVE-CARE UNITS, TRENDS, CANADA, Pediatrics, Perinatology and Child Health, Outcomes research, business, Life Sciences & Biomedicine
Abstract

Neonates born very preterm (before 32 weeks’ gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.

Published
2019

4. The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities

Author

Shah P, Lui K, Reichman B, Norman M, Kusuda S, Lehtonen L, Adams M, Vento M, Darlow B, Modi N, Rusconi F, Hakansson S, San Feliciano L, Helenius K, Bassler D, Hirano S, Lee S, Marshall P, Schmidt P, Dhawan A, Craven P, de Waal K, Simmer K, Gill A, Pillow J, Stack J, Birch P, Cooke L, Casalaz D, Holberton J, Stewart A, Downe L, Stewart M, Bajuk B, Berry A, Hunt R, Kilburn C, De Paoli T, Bolisetty S, Paradisis M, Rieger I, Koorts P, Kuschel C, Numa A, Carlisle H, Badawi N, Loughran-Fowlds A, Koh G, Davis J, Luig M, Andersen C, Chambers G, Austin N, Lynn A, Edmonds L, Mildenhall L, Buksh M, Battin M, van den Boom J, Bourchier D, Richardson V, Dineen F, Rajadurai V, Fung G, Harrison A, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Aziz K, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee K, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Beltempo M, Bertelle V, Masse E, Canning R, Mabry H, Ojah C, Monterrosa L, Deshpandey A, Afifi J, Kajetanowicz A, Andersson S, Tammela O, Sankilampi U, Saarela T, Prazad P, Noguchi A, McWan K, Button B, Stratton W, Hamvus A, Raghaven A, Derrick M, Hadley R, Covert R, Lablanc O, Weiss M, Bell A, Shareef M, Silvestri J, Heymann E, Zangen S, Smolkin T, Mimouni F, Bader D, Rothschild A, Strauss Z, Felszer C, Oman H, Toy-Friedman S, Bar-Oz B, Feldman M, Saad N, Flidel-Rimon O, Weisbrod M, Lubin D, Litmanovitz I, Kngelman A, Shinwell E, Klinger G, Nijim Y, Bin-Nun A, Golan A, Mandel D, Fleisher-Sheffer V, Kohelet D, Bakhrakh L, Hattori S, Shirai M, Ishioka T, Mori T, Amiznka T, Huchimukai T, Yoshida H, Sasaki A, Shimizu J, Nakamura T, Maruyama M, Matsumoto H, Hosokawa S, Taki A, Nakagawa M, Ko K, Uozumi A, Nakata S, Shimazaki A, Yoda T, Numata O, Imamura H, Kobayashi A, Tokuriki S, Uchida Y, Arai T, Ito M, Ieda K, Ono T, Hayashi M, Maki K, Yamakawa M, Kawai M, Fujii N, Shiomi K, Nozaki K, Wada H, Kim T, Tokunaga Y, Takatera A, Oshima T, Sumida H, Michinomae Y, Knsumoto Y, Yoshimoto S, Morisawa T, Ohashi T, Takahashi Y, Sugimoto M, Ono N, Miyagawa S, Saijo T, Yamagami T, Koyano K, Kobayashi S, Kanda T, Sakemi Y, Aoki M, Iida K, Goshi M, Maruyama Y, Avila-Alvarez A, Fernandez-Trisac J, Pico M, Seara M, Gutierrez A, Vizcaino C, Iglesias M, Zaplana H, Colomer B, Lopez J, Mozo R, Martinez M, Sebastian M, Carbonell M, Bamnsell J, Puiggros M, Aloy J, Mussons F, Sanz I, Galiana G, Coroleu W, Iriondo M, Vilella L, Porta R, Demestre X, Nadal S, Martinez C, Cuesta M, Mora D, Tardio J, Benavente I, Alonso A, Olmos R, Cabezas M, Jimenez M, Caballero M, Diaz M, Fagundo A, Canals L, Rodrigo F, Marti L, Galdo M, Suazo J, Lopez E, Fernandez J, Altana M, Navarro D, Dominguez M, del Prado M, Diez I, Benavides M, Lapena S, Prada T, Mir E, Sanchez A, Vega E, del Prado N, Fernandez C, Vilaplana L, Perez I, Gomez L, Comeche L, Martin I, Armengod C, Labian C, Munoz M, Bravo D, Perez V, Fernandez M, Gonzalez C, Segura S, Azorin M, Jimenez A, Sanchez-Tamayo T, Moreno E, Gonzalez M, Martinez J, Garcia J, Orayen C, Gonzalez J, Albo M, Colmenero E, Gonzalez E, del Arco B, Gordillo L, Asensio M, Diaz C, Albujar M, Jorge P, Romero S, Falero M, Izquierdo A, Capell J, Macian M, Vicente M, Caballero R, Euba A, Serna A, Goya J, Legorburu A, Amoros A, Isabel V, Gonzalez N, Gracia S, Faci M, Villagrasa M, Kofron J, Brodd K, Odlind A, Alberg L, Arwehed S, Hafstrom O, Kasemo A, Nederman K, Ahman L, Ingemarsson F, Petersson H, Thum P, Albinsson E, Selander B, Abrahamsson T, Heimdahl I, Sveinsdottir K, Wejryd E, Hedlund A, Soderberg M, Hallberg B, Brune T, Backstrom J, Robinson J, Farooqi A, Normann E, Fredriksson M, Palm A, Rosenqvist U, Hagman C, Ohlin A, Floral R, Smedsaas-Lofvenberg A, Meyer P, Anderegg C, Schulzke S, Nelle M, Wagner B, Riedel T, Kaczala G, Walde B, Pfister R, Tolsa J, Roth M, Stocker M, Laubscher B, Malzacher A, Micallef J, Hegi L, Arlettaz R, Bernet V, Dani C, Fiorini P, Boldrini A, Tomasini B, Mittal A, Kefas J, Kamalanathan A, Jayachandran, Yoxall B, McBride T, Webb D, Garr R, Hassan A, Ambadkar P, Dyke M, McDevitt K, Rewitzky G, D'Amore A, Panasa N, Settle P, Maddock N, Edi-Osagie N, Zipitis C, Heal C, Birch J, Hasib A, Soe A, Kumar N, Kisat H, Vasu V, Lama M, Gupta R, Rawlingson C, Wickham T, Theron M, Kendall G, Gupta A, Aladangady N, Ali I, Alsford L, Lopez W, Murthy V, Sullivan C, Thomas M, Bate T, Godambe S, Watts T, Kuna J, Chang J, Pai V, Huddy C, Yasin S, Nicholl R, Pandey P, Kairamkonda V, Muogbo D, Harry L, Simmons P, Nycyk J, Gallagher A, Pillay T, Deshpande S, Mahadevan, Moore A, Clark S, Garbash M, Lal M, Abu-Harb M, Allwood A, Selter M, Munyard P, Bartle D, Paul S, Whincup G, Mallik A, Amess P, Godden C, Reynolds P, Misra I, De Halpert P, Salgia S, Sanghavi R, Wigfield R, Deketelaere A, Khashu M, Hall M, Groves C, Brown N, Brennan N, Vamvakiti K, McIntyre J, Pirie S, Jones S, Mannix P, Cairns P, Eaton M, Schwarz K, Gibson D, Miall L, Krishnamurthy, and Int Network Evaluating Outcomes iN

Subjects
outcomes research, neonatal intensive care, Preterm infants
Abstract

Neonates born very preterm (before 32 weeks' gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.

Published
2019

5. Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

Author

Lui K, Lee S, Kusuda S, Adams M, Vento M, Reichman B, Darlow B, Lehtonen L, Modi N, Norman M, Hakansson S, Bassler D, Rusconi F, Lodha A, Yang J, Shah P, Marshall P, Schmidt P, Dhawan A, Craven P, de Waal K, Simmer K, Gill A, Pillow J, Stack J, Birch P, Cooke L, Casalaz D, Holberton J, Stewart A, Downe L, Stewart M, Bajuk B, Berry A, Hunt R, Kilburn C, De Paoli T, Bolisetty S, Paradisis M, Rieger I, Koorts P, Kuschel C, Doyle L, Numa A, Carlisle H, Badawi N, Loughran-Fowlds A, Koh G, Davis J, Luig M, Andersen C, Chambers G, Austin N, Lynn A, Edmonds L, Mildenhall L, Buksh M, Battin M, van den Boom J, Bourchier D, Richardson V, Dineen F, Rajadurai V, Lam S, Fung G, Harrison A, Synnes A, Cieslak Z, Sherlock R, Yee W, Aziz K, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee K, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Beltempo M, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Deshpandey A, Afifi J, Kajetanowicz A, Andersson S, Tammela O, Sankilampi U, Saarela T, Prazad P, Noguchi A, McWan K, Button B, Stratton W, Hamvus A, Raghaven A, Derrick M, Hadley R, Covert R, Lablanc O, Weiss M, Bell A, Shareef M, Silvestri J, Heymann E, Zangen S, Smolkin T, Mimouni F, Bader D, Rothschild A, Strauss Z, Felszer C, Omari H, Tov-Friedman S, Bar-Oz B, Feldman M, Saad N, Flidel-Rimon O, Weisbrod M, Lubin D, Litmanovitz I, Kugelman A, Shinwell E, Klinger G, Nijim Y, Bin-Nun A, Golan A, Mandel D, Fleisher-Sheffer V, Kohelet D, Bakhrakh L, Hattori S, Shirai M, Ishioka T, Mori T, Amizuka T, Huchimukai T, Yoshida H, Sasaki A, Shimizu J, Nakamura T, Maruyama M, Matsumoto H, Hosokawa S, Taki A, Nakagawa M, Ko K, Uozumi A, Nakata S, Shimazaki A, Yoda T, Numata O, Imamura H, Kobayashi A, Tokuriki S, Uchida Y, Arai T, Ito M, Ieda K, Ono T, Hayashi M, Maki K, Yamakawa M, Kawai M, Fujii N, Shiomi K, Nozaki K, Wada H, Kim T, Tokunaga Y, Takatera A, Oshima T, Sumida H, Michinomae Y, Kusumoto Y, Yoshimoto S, Morisawa T, Ohashi T, Takahashi Y, Sugimoto M, Ono N, Miyagawa S, Saijo T, Yamagami T, Koyano K, Kobayashi S, Kanda T, Sakemi Y, Aoki M, Iida K, Goshi M, Maruyama Y, Avila-Alvarez A, Ting J, Toye J, Fernandez-Trisac J, Pico M, Seara M, Gutierrez A, Vizcaino C, Iglesias M, Zaplana H, Colomer B, Lopez J, Mozo R, Martinez M, Sebastian M, Carbonell M, Barnusell J, Puiggros M, Aloy J, Mussons F, Sanz I, Galiana G, Coroleu W, Iriondo M, Vilella L, Porta R, Demestre X, Nadal S, Martinez C, Cuesta M, Mora D, Tardio J, Benavente I, Alonso A, Olmos R, Cabezas M, Jimenez M, Caballero P, Diaz M, Fagundo A, Canals L, Rodrigo F, Marti L, Galdo M, Suazo J, Lopez E, Fernandez J, Altuna M, Muga O, Navarro D, Dominguez M, del Prado M, Diez I, Benavides M, Lapena S, Prada T, Mir E, Sanchez A, Vega E, del Prado N, Fernandez C, Vilaplana L, Perez I, Gomez L, Comeche L, Martin I, Armengod C, Labian C, Munoz M, Bravo D, Perez V, Fernandez M, Gonzalez C, Segura S, Azorin M, Jimenez A, Sanchez-Tamayo T, Moreno E, Gonzalez M, Martinez J, Garcia J, Orayen C, Gonzalez J, Albo M, Colmenero E, Gonzalez E, del Arco B, Gordillo L, Asensio M, Diaz C, Albujar R, Jorge P, Romero S, Falero M, Izquierdo A, Capell J, Vicente M, Caballero R, Euba A, Serna A, Goya J, Legorburu A, Amoros A, Isabel V, Gonzalez N, Gracia S, Faci P, Villagrasa M, Macian M, Kofron J, Brodd K, Odlind A, Alberg L, Arwehed S, Hafstrom O, Kasemo A, Nederman K, Ahman L, Ingemarsson F, Petersson H, Thurn P, Albinsson E, Selander B, Abrahamsson T, Heimdahl I, Sveinsdottir K, Wejryd E, Hedlund A, Soderberg M, Hallberg B, Brune T, Backstrom J, Robinson J, Farooqi A, Normann E, Fredriksson M, Palm A, Rosenqvist U, Walde B, Hagman C, Ohlin A, Florell R, Smedsaas-Lofvenberg A, Meyer P, Anderegg C, Schulzke S, Nelle M, Wagner B, Riedel T, Kaczala G, Pfister R, Tolsa J, Roth M, Stocker M, Laubscher B, Malzacher A, Micallef J, Hegi L, Arlettaz R, Bernet V, Fiorini P, Boldrini A, Tomasini B, Kefas J, Kamalanathan A, Jayachandran, Yoxall B, McBride T, Webb D, Garr R, Hassan A, Ambadkar P, Dyke M, McDevitt K, Rewitzky G, D'Amore A, Panasa N, Settle P, Maddock N, Edi-Osagie N, Zipitis C, Heal C, Birch J, Hasib A, Soe A, Kumar N, Kisat H, Vasu V, Lama M, Gupta R, Rawlingson C, Wickham T, Theron M, Kendall G, Gupta A, Aladangady N, Ali I, Alsford L, Lopez W, Murthy V, Sullivan C, Thomas M, Bate T, Godambe S, Watts T, Kuna J, Chang J, Pai V, Huddy C, Yasin S, Nicholl R, Pandey P, Cusack J, Kairamkonda V, Muogbo D, Harry L, Simmons P, Nycyk J, Gallagher A, Pillay T, Deshpande S, Mahadevan, Moore A, Clark S, Garbash M, Lal M, Abu-Harb M, Dani C, Mittal A, Allwood A, Selter M, Munyard P, Bartle D, Paul S, Whincup G, Mallik A, Amess P, Godden C, Reynolds P, Misra I, De Halpert P, Salgia S, Sanghavi R, Wigfield R, Deketelaere A, Khashu M, Hall M, Groves C, Brown N, Brennan N, Vamvakiti K, McIntyre J, Pirie S, Jones S, Mannix P, Cairns P, Eaton M, Schwarz K, Gibson D, Miall L, Krishnamurthy, and Int Network Evaluation Outcomes iN

Abstract

Objective To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. Study design In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 24(0/7) to 31(6/7) weeks of gestational age and birth weight

Published
2019

7. International, multicentre, observational study of fluid bolus therapy in neonates

Author

Keir, AK, Karam, O, Hodyl, N, Stark, MJ, Liley, HG, Shah, PS, Stanworth, SJ, Morris, S, Carmo, KB, De Waal, K, Stubbs, M, Liley, H, Pearson, A, Campbell, H, Hunt, RW, Perkins, E, Ali, SKM, Bowen, J, Jacobs, C, Paradisis, M, Osborn, D, Greenhalgh, M, Kuschel, C, Stark, M, Keir, A, Ting, J, Barrington, K, Lapointe, A, Dow, K, Coo, H, Mukerji, A, Mohamed, A, Stavel, M, Deshpandey, A, Tucker, N, Ng, E, Diamond, C, Bourgoin, P, Bindl, L, Maria, M, De Luca, D, Dell'Orto, V, Ghirardello, S, More, K, Edmonds, L, Weaver, L, Deschmann, E, Norman, M, Thomas, O, Karlsson, J, De Luca, R, Rogdo, B, Moinho, R, Dinis, A, Wilkinson, D, Paria, A, Sola-Visner, M, Young, V, Josephson, CD, Skvarich, J, Saxonhouse, M, Poliquin, R, Courtney, S, Janssen, D, Harm, SK, Bartlett, A, Mayock, D, Lee, G, Keir, AK, Karam, O, Hodyl, N, Stark, MJ, Liley, HG, Shah, PS, Stanworth, SJ, Morris, S, Carmo, KB, De Waal, K, Stubbs, M, Liley, H, Pearson, A, Campbell, H, Hunt, RW, Perkins, E, Ali, SKM, Bowen, J, Jacobs, C, Paradisis, M, Osborn, D, Greenhalgh, M, Kuschel, C, Stark, M, Keir, A, Ting, J, Barrington, K, Lapointe, A, Dow, K, Coo, H, Mukerji, A, Mohamed, A, Stavel, M, Deshpandey, A, Tucker, N, Ng, E, Diamond, C, Bourgoin, P, Bindl, L, Maria, M, De Luca, D, Dell'Orto, V, Ghirardello, S, More, K, Edmonds, L, Weaver, L, Deschmann, E, Norman, M, Thomas, O, Karlsson, J, De Luca, R, Rogdo, B, Moinho, R, Dinis, A, Wilkinson, D, Paria, A, Sola-Visner, M, Young, V, Josephson, CD, Skvarich, J, Saxonhouse, M, Poliquin, R, Courtney, S, Janssen, D, Harm, SK, Bartlett, A, Mayock, D, and Lee, G

Abstract

AIM: To assess the prevalence, types and indications for fluid bolus therapy in neonates with haemodynamic compromise. METHODS: This was a pragmatic, international, multicentre observational study in neonatal units across Australasia, Europe and North America with a predefined study period of 10-15 study days per participating neonatal unit between December 2015 and March 2017. Infants ≤28 days of age who received a fluid bolus for the management of haemodynamic compromise (≥10 mL/kg given at ≤6 h) were included. RESULTS: A total of 163 neonates received a bolus over 8479 eligible patient days in 41 neonatal units. Prevalence of fluid bolus therapy varied between centres from 0 to 28.6% of admitted neonates per day, with a pooled prevalence rate of 1.5% (95% confidence interval 1.1-1.9%). The most common fluid used was 0.9% sodium chloride (129/163; 79%), and the volume of fluid administered was most commonly 10 mL/kg (115/163; 71%) over a median of 30 min (interquartile range 20-60). The most frequent indications were hypotension (n = 56; 34%), poor perfusion (n = 20; 12%) and metabolic acidosis (n = 20; 12%). Minimal or no clinical improvement was reported by clinicians in 66 of 163 cases (40%). CONCLUSIONS: Wide international variations in types, indications and effects of fluid bolus administration in haemodynamically compromised neonates suggest uncertainty in the risk-benefit profile. This is likely to reflect the lack of robust evidence to support the efficacy of different fluid types, doses and appropriate indications. Together, these highlight a need for further clinically relevant studies.

Published
2019

8. Prediction of outcomes of extremely low gestational age newborns in Australia and New Zealand

Author

Yeo, KT, Safi, N, Wang, YA, Le Marsney, R, Schindler, T, Bolisetty, S, Haslam, R, Lui, K, Marshall, P, Schmidt, P, Craven, P, De Waal, K, Simmer, K, Gill, A, Pillow, J, Stack, J, Cooke, L, Casalaz, D, Holberton, J, Barfield, C, Downe, L, Singde, V, Stewart, M, Berry, A, Carmo, KB, Hunt, R, Kilburn, C, De Paoli, T, Paradisis, M, Rieger, I, Lutz, T, Reid, S, Cartwright, D, Koorts, P, Kuschel, C, Doyle, L, Numa, A, Carlisle, H, Badawi, N, Koh, G, Resnick, S, Luig, M, Andersen, C, Lyn, A, Darlow, B, Broadbent, R, Mildenhall, L, Buksh, M, Bourchier, D, Carpenter, L, Richardson, V, Chambers, G, Buckmaster, A, Rajadurai, VS, and Bajuk, B

Abstract

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. Objective To determine the accuracy of the National Institute of Child Health and Human Development (NICHD) calculator in predicting death and neurodevelopmental impairment in Australian and New Zealand infants. Design Population-based cohort study. setting Australia and New Zealand. Patients Preterm infants 22–25 completed weeks gestation. Interventions Comparison of NICHD calculator predicted rates of death and death or neurodevelopmental impairment, with actual rates recorded in the Australian and New Zealand Neonatal Network cohort. Main outcome measures Infant death and death or neurodevelopmental impairment rates. results A total of 714 infants were included in the study. Of these infants, 100 (14.0%) were

Published
2017

9. Dwell time and risk of central-line-associated bloodstream infection in neonates

Author

Sanderson, E, Yeo, KT, Wang, AY, Callander, I, Bajuk, B, Bolisetty, S, Lui, K, Bowen, J, Sedgley, S, Carlisle, H, Kent, A, Smith, J, Craven, P, Cruden, L, Argomand, A, Rieger, I, Malcolm, G, Lutz, T, Reid, S, Stack, J, Medlin, K, Marcin, K, Shingde, V, Chin, MF, Bonzer, K, Badawi, N, Halliday, R, Karskens, C, Paradisis, M, Kluckow, M, Jacobs, C, Numa, A, Williams, G, Young, J, Luig, M, Baird, J, Oei, JL, and Cameron, D

Subjects
Male, Catheterization, Central Venous, Time Factors, Epidemiology, Sepsis, Incidence, Catheter-Related Infections, Infant, Newborn, Humans, Female, Prospective Studies, Risk Assessment, Retrospective Studies
Abstract

© 2017 The Healthcare Infection Society Background Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). Aim To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. Methods The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). Findings There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan–Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12–20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. Conclusion There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.

Published
2017

10. Prediction of outcomes of extremely low gestational age newborns in Australia and New Zealand.

Author

Yeo K.T., Wang Y.A., Le Marsney R., Schindler T., Bolisetty S., Haslam R., Lui K., Marshall P., Schmidt P., Craven P., De Waal K., Simmer K., Gill A., Pillow J., Stack J., Cooke L., Casalaz D., Holberton J., Barfield C., Downe L., Singde V., Stewart M., Berry A., Carmo K.B., Darlow B., Broadbent R., Mildenhall L., Buksh M., Bourchier D., Carpenter L., Richardson V., Chambers G., Buckmaster A., Rajadurai V.S., Bajuk B., Safi N., Hunt R., Kilburn C., De Paoli T., Paradisis M., Rieger I., Lutz T., Reid S., Cartwright D., Koorts P., Kuschel C., Doyle L., Numa A., Carlisle H., Badawi N., Koh G., Resnick S., Luig M., Andersen C., Lyn A., Yeo K.T., Wang Y.A., Le Marsney R., Schindler T., Bolisetty S., Haslam R., Lui K., Marshall P., Schmidt P., Craven P., De Waal K., Simmer K., Gill A., Pillow J., Stack J., Cooke L., Casalaz D., Holberton J., Barfield C., Downe L., Singde V., Stewart M., Berry A., Carmo K.B., Darlow B., Broadbent R., Mildenhall L., Buksh M., Bourchier D., Carpenter L., Richardson V., Chambers G., Buckmaster A., Rajadurai V.S., Bajuk B., Safi N., Hunt R., Kilburn C., De Paoli T., Paradisis M., Rieger I., Lutz T., Reid S., Cartwright D., Koorts P., Kuschel C., Doyle L., Numa A., Carlisle H., Badawi N., Koh G., Resnick S., Luig M., Andersen C., and Lyn A.

Abstract

Objective To determine the accuracy of the National Institute of Child Health and Human Development (NICHD) calculator in predicting death and neurodevelopmental impairment in Australian and New Zealand infants. Design Population-based cohort study. setting Australia and New Zealand. Patients Preterm infants 22-25 completed weeks gestation. Interventions Comparison of NICHD calculator predicted rates of death and death or neurodevelopmental impairment, with actual rates recorded in the Australian and New Zealand Neonatal Network cohort. Main outcome measures Infant death and death or neurodevelopmental impairment rates. results A total of 714 infants were included in the study. Of these infants, 100 (14.0%) were <24 weeks, 389 (54.5%) male, 529 (74.1%) were singletons, 42 (5.9%) had intrauterine growth restriction, 563 (78.9%) received antenatal steroids and 625 (87.5 %) were born in a tertiary hospital. There were 288 deaths (40.3%), 75 infants (10.5%) with neurodevelopment impairment and 363 (50.8%) with death or neurodevelopmental impairment. The area under the curve (AUC) for prediction of death and the composite death or neurodevelopmental impairment by the NICHD calculator in our population was 0.65(95% CI 0.61 to 0.69) and 0.65 (95% CI 0.61 to 0.69), respectively. When stratified and compared with gestational age outcomes, the AUC did not change substantially for the outcomes investigated. The calculator was less accurate with outcome predictions at the extreme categories of predicted outcomes-underestimation of outcomes for those predicted to have the lowest risk (<20%) and overestimation for those in the highest risk category (>>80%). conclusion In our recent cohort of extremely preterm infants, the NICHD model does not accurately predict outcomes and is marginally better than gestational age based outcomes.Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.

Published
2018

11. Dwell time and risk of central-line-associated bloodstream infection in neonates

Author

Sanderson, E., primary, Yeo, K.T., additional, Wang, A.Y., additional, Callander, I., additional, Bajuk, B., additional, Bolisetty, S., additional, Lui, K., additional, Bowen, J., additional, Sedgley, S., additional, Carlisle, H., additional, Kent, A., additional, Smith, J., additional, Craven, P., additional, Cruden, L., additional, Argomand, A., additional, Rieger, I., additional, Malcolm, G., additional, Lutz, T., additional, Reid, S., additional, Stack, J., additional, Medlin, K., additional, Marcin, K., additional, Shingde, V., additional, Chin, M.F., additional, Bonzer, K., additional, Badawi, N., additional, Halliday, R., additional, Karskens, C., additional, Paradisis, M., additional, Kluckow, M., additional, Jacobs, C., additional, Numa, A., additional, Williams, G., additional, Young, J., additional, Luig, M., additional, Baird, J., additional, Oei, J.-L., additional, and Cameron, D., additional

Published
2017
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12. Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants.

Author

Austin N., Andersen C., Darlow B., Broadbent R., Corban J., Mildenhall L., Battin M., Bourchier D., Richardson V., Haslam R., Rajadurai V.S., Kajetanowicz A., Synnes A., Rouvinez-Bouali N., Piedboeuf B., Bertelle V., Bulleid B., Yee W., Shivananda S., Lee K.-S., Seshia M., Barrington K., Lefebvre F., McMillan D., Andrews W., Kovacs L., Dow K., da Silva O., Riley P., Peliowski A., Aziz K., Cieslak Z., Kalapesi Z., Sankaran K., Faucher D., Alvaro R., Canning R., Ojah C., Monterrosa L., Dunn M., Sorokan T., Harrison A., Nwaesei C., Adie M., Hakansson S., Segerdahl N., Morad T., Moren S., Stenberg A., Simonsson C., Stigsson L., Christensen J.L., Amasn L., Ingemanson F., osterdal L., Ellstrom K.-G., Abrahamsson T., Heimdahl I., Hagg T., Hedlund A., Lund E.E., Westrup B., Sarman I., Jobe A.S., Fredsriksson M., Palm A., Malmstrom B., Lindberg E., Ljungdahl O., Eriksson K., Koller-Smith L.I.M., Shah P., Ye X.Y., Sjors G., Wang Y.A., Chow S.S.W., Darlow B.A., Lee S.K., Hakanson S., Lui K., Marshall P., Craven P., Simmer K., Stack J., Knight D., Watkins A., Ramsden A., Tan K., Bawden K., Downe L., Singde V., Stewart M., Berry A., Hunt R., Kilburn C., Dargaville P., Paradisis M., Evans N., Reid S., Cartwright D., Kuschel C., Doyle L., Numa A., Kecskes Z., Badawi N., Koh G., Resnick S., Tracy M., Tarnow-Mordi W., Austin N., Andersen C., Darlow B., Broadbent R., Corban J., Mildenhall L., Battin M., Bourchier D., Richardson V., Haslam R., Rajadurai V.S., Kajetanowicz A., Synnes A., Rouvinez-Bouali N., Piedboeuf B., Bertelle V., Bulleid B., Yee W., Shivananda S., Lee K.-S., Seshia M., Barrington K., Lefebvre F., McMillan D., Andrews W., Kovacs L., Dow K., da Silva O., Riley P., Peliowski A., Aziz K., Cieslak Z., Kalapesi Z., Sankaran K., Faucher D., Alvaro R., Canning R., Ojah C., Monterrosa L., Dunn M., Sorokan T., Harrison A., Nwaesei C., Adie M., Hakansson S., Segerdahl N., Morad T., Moren S., Stenberg A., Simonsson C., Stigsson L., Christensen J.L., Amasn L., Ingemanson F., osterdal L., Ellstrom K.-G., Abrahamsson T., Heimdahl I., Hagg T., Hedlund A., Lund E.E., Westrup B., Sarman I., Jobe A.S., Fredsriksson M., Palm A., Malmstrom B., Lindberg E., Ljungdahl O., Eriksson K., Koller-Smith L.I.M., Shah P., Ye X.Y., Sjors G., Wang Y.A., Chow S.S.W., Darlow B.A., Lee S.K., Hakanson S., Lui K., Marshall P., Craven P., Simmer K., Stack J., Knight D., Watkins A., Ramsden A., Tan K., Bawden K., Downe L., Singde V., Stewart M., Berry A., Hunt R., Kilburn C., Dargaville P., Paradisis M., Evans N., Reid S., Cartwright D., Kuschel C., Doyle L., Numa A., Kecskes Z., Badawi N., Koh G., Resnick S., Tracy M., and Tarnow-Mordi W.

Abstract

Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method(s): Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Result(s): VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and >=32 weeks, AUC 0.50-0.65; >=1500 g and <32 weeks, AUC 0.60-0.62). Conclusion(s): There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.Copyright © 2017 The Author(s).

Published
2017

13. Survival in very preterm infants: An international comparison of 10 national neonatal networks.

Author

Cooke L., Helenius K., Sjors G., Shah P.S., Modi N., Reichman B., Morisaki N., Kusuda S., Lui K., Darlow B., Bassler D., Hakansson S., Adams M., Vento M., Rusconi F., Isayama T., Lee S.K., Lehtonen L., Haslam R., Marshall P., Schmidt P., Buckmaster A., Craven P., De Waal K., Simmer K., Gill A., Pillow J., Stack J., Casalaz D., Holberton J., Barfield C., Downe L., Shingde V., Stewart M., Bajuk B., Berry A., Hunt R., Kilburn C., De Paoli T., Paradisis M., Rieger I., Reid S., Cartwright D., Koorts P., Kuschel C., Doyle L., Numa A., Carlisle H., Badawi N., Halliday R., Koh G., Resnick S., Luig M., Anderson C., Chambers G., Lynn A., Broadbent R., Mildenhall L., Batten M., Van Den Boom J., Bourchier D., Carpenter L., Richardson V., Rajadurai V.S., Cooke L., Helenius K., Sjors G., Shah P.S., Modi N., Reichman B., Morisaki N., Kusuda S., Lui K., Darlow B., Bassler D., Hakansson S., Adams M., Vento M., Rusconi F., Isayama T., Lee S.K., Lehtonen L., Haslam R., Marshall P., Schmidt P., Buckmaster A., Craven P., De Waal K., Simmer K., Gill A., Pillow J., Stack J., Casalaz D., Holberton J., Barfield C., Downe L., Shingde V., Stewart M., Bajuk B., Berry A., Hunt R., Kilburn C., De Paoli T., Paradisis M., Rieger I., Reid S., Cartwright D., Koorts P., Kuschel C., Doyle L., Numa A., Carlisle H., Badawi N., Halliday R., Koh G., Resnick S., Luig M., Anderson C., Chambers G., Lynn A., Broadbent R., Mildenhall L., Batten M., Van Den Boom J., Bourchier D., Carpenter L., Richardson V., and Rajadurai V.S.

Abstract

OBJECTIVES: To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHOD(S): A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. RESULT(S): Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. CONCLUSION(S): The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.© Copyright 2017 by the American Academy of Pediatrics.

Published
2017

14. Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

Author

Koller-Smith, LIM, Shah, PS, Ye, XY, Sjörs, G, Wang, YA, Chow, SSW, Darlow, BA, Lee, SK, Håkanson, S, Lui, K, Marshall, P, Craven, P, Simmer, K, Stack, J, Knight, D, Watkins, A, Ramsden, A, Tan, K, Bawden, K, Downe, L, Singde, V, Stewart, M, Berry, A, Hunt, R, Kilburn, C, Dargaville, P, Paradisis, M, Evans, N, Reid, S, Cartwright, D, Kuschel, C, Doyle, L, Numa, A, Kecskes, Z, Badawi, N, Koh, G, Resnick, S, Tracy, M, Tarnow-Mordi, W, Andersen, C, Austin, N, Darlow, B, Broadbent, R, Corban, J, Mildenhall, L, Battin, M, Bourchier, D, Richardson, V, Haslam, R, Rajadurai, VS, Kajetanowicz, A, Synnes, A, Rouvinez-Bouali, N, Piedboeuf, B, Bertelle, V, Bulleid, B, Yee, W, Shivananda, S, Lee, KS, Seshia, M, Barrington, K, Lefebvre, F, McMillan, D, Andrews, W, Kovacs, L, Dow, K, da Silva, O, Riley, P, Peliowski, A, Aziz, K, Cieslak, Z, Kalapesi, Z, Sankaran, K, Faucher, D, Alvaro, R, Canning, R, Ojah, C, Monterrosa, L, Dunn, M, Sorokan, T, Harrison, A, Nwaesei, C, Adie, M, Håkansson, S, Segerdahl, N, Morad, T, Morén, S, Stenberg, Å, Simonsson, C, Stigsson, L, Christensen, JL, Åmasn, L, Ingemanson, F, österdal, L, Ellström, KG, Abrahamsson, T, Heimdahl, I, Hägg, T, Hedlund, A, Lund, EE, Koller-Smith, LIM, Shah, PS, Ye, XY, Sjörs, G, Wang, YA, Chow, SSW, Darlow, BA, Lee, SK, Håkanson, S, Lui, K, Marshall, P, Craven, P, Simmer, K, Stack, J, Knight, D, Watkins, A, Ramsden, A, Tan, K, Bawden, K, Downe, L, Singde, V, Stewart, M, Berry, A, Hunt, R, Kilburn, C, Dargaville, P, Paradisis, M, Evans, N, Reid, S, Cartwright, D, Kuschel, C, Doyle, L, Numa, A, Kecskes, Z, Badawi, N, Koh, G, Resnick, S, Tracy, M, Tarnow-Mordi, W, Andersen, C, Austin, N, Darlow, B, Broadbent, R, Corban, J, Mildenhall, L, Battin, M, Bourchier, D, Richardson, V, Haslam, R, Rajadurai, VS, Kajetanowicz, A, Synnes, A, Rouvinez-Bouali, N, Piedboeuf, B, Bertelle, V, Bulleid, B, Yee, W, Shivananda, S, Lee, KS, Seshia, M, Barrington, K, Lefebvre, F, McMillan, D, Andrews, W, Kovacs, L, Dow, K, da Silva, O, Riley, P, Peliowski, A, Aziz, K, Cieslak, Z, Kalapesi, Z, Sankaran, K, Faucher, D, Alvaro, R, Canning, R, Ojah, C, Monterrosa, L, Dunn, M, Sorokan, T, Harrison, A, Nwaesei, C, Adie, M, Håkansson, S, Segerdahl, N, Morad, T, Morén, S, Stenberg, Å, Simonsson, C, Stigsson, L, Christensen, JL, Åmasn, L, Ingemanson, F, österdal, L, Ellström, KG, Abrahamsson, T, Heimdahl, I, Hägg, T, Hedlund, A, and Lund, EE

Abstract

© 2017 The Author(s). Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.

Published
2017

21. Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

Author

Louise Koller-Smith, Shah, Ps, Ye, Xy, Sjörs, G., Wang, Ya, Chow, Ssw, Darlow, Ba, Lee, Sk, Håkanson, S., Lui, K., Marshall, P., Craven, P., Simmer, K., Stack, J., Knight, D., Watkins, A., Ramsden, A., Tan, K., Bawden, K., Downe, L., Singde, V., Stewart, M., Berry, A., Hunt, R., Kilburn, C., Dargaville, P., Paradisis, M., Evans, N., Reid, S., Cartwright, D., Kuschel, C., Doyle, L., Numa, A., Kecskes, Z., Badawi, N., Koh, G., Resnick, S., Tracy, M., Tarnow-Mordi, W., Andersen, C., Austin, N., Darlow, B., Broadbent, R., Corban, J., Mildenhall, L., Battin, M., Bourchier, D., Richardson, V., Haslam, R., Rajadurai, Vs, Kajetanowicz, A., Synnes, A., Rouvinez-Bouali, N., Piedboeuf, B., Bertelle, V., Bulleid, B., Yee, W., Shivananda, S., Lee, Ks, Seshia, M., Barrington, K., Lefebvre, F., Mcmillan, D., Andrews, W., Kovacs, L., Dow, K., Da Silva, O., Riley, P., Peliowski, A., Aziz, K., Cieslak, Z., Kalapesi, Z., Sankaran, K., Faucher, D., Alvaro, R., Canning, R., Ojah, C., Monterrosa, L., Dunn, M., Sorokan, T., Harrison, A., Nwaesei, C., Adie, M., Håkansson, S., Segerdahl, N., Morad, T., Morén, S., Stenberg, Å, Simonsson, C., Stigsson, L., Christensen, Jl, Åmasn, L., Ingemanson, F., Österdal, L., Ellström, Kg, Abrahamsson, T., Heimdahl, I., Hägg, T., Hedlund, A., and Lund, Ee

Subjects
Male, Canada, Gestational Age, Infant, Premature, Diseases, Pediatrics, Decision Support Techniques, Risk Factors, Infant Mortality, Humans, Infant, Very Low Birth Weight, Hospital Mortality, Selection Bias, Retrospective Studies, Sweden, Models, Statistical, Infant, Newborn, Australia, Infant, Prognosis, Benchmarking, ROC Curve, Area Under Curve, Infant, Extremely Premature, Infant, Small for Gestational Age, Intensive Care, Neonatal, Female, Infant, Premature, New Zealand
Abstract

© 2017 The Author(s). Background: Compared to very low gestational age (

22. Relationship between systemic blood flow, blood pressure, inotropes, and aEEG in the first 48 h of life in extremely preterm infants.

Author

Shah D, Paradisis M, and Bowen JR

Subjects
Analysis of Variance, Blood Circulation drug effects, Blood Pressure drug effects, Humans, Infant, Newborn, New South Wales, Regression Analysis, Vena Cava, Superior physiology, Ventricular Function, Right physiology, Blood Circulation physiology, Blood Pressure physiology, Cardiotonic Agents pharmacology, Electroencephalography methods, Infant, Extremely Premature physiology
Abstract

Background: Significant hemodynamic changes occur immediately after birth in preterm infants. Amplitude-integrated electroencephalography (aEEG) provides a method of assessing brain activity in sick neonates; however, the relationship among systemic blood flow, blood pressure (BP), and aEEG is not clear., Methods: Quantitative measures of aEEG continuity and amplitude were correlated with superior vena cava (SVC) flow, right-ventricular output (RVO), and BP at 12, 24, and 48 h in 92 infants born at <29 wk gestation., Results: SVC flow, RVO, BP, aEEG amplitude, and EEG continuity all increased from 12 to 48 h. SVC flow at 12 h, but not 24 or 48 h, was significantly associated with aEEG amplitude after adjustment for gestational age (GA) and severity of illness markers (r(2) = 0.21, P = 0.004). RVO and BP showed less consistent associations with aEEG parameters. Infants receiving inotropes at 12 h, including those in whom cardiovascular parameters had normalized, had significantly lower aEEG amplitude (P < 0.01) and EEG continuity at the 10, 25, and 50 μV levels (P < 0.01) at 12, 24, and 48 h than neonates who were not receiving inotropes., Conclusion: aEEG measurements in the first 48 h of life are related to SVC flow and treatment with inotropes at 12 h of life in extremely preterm infants.

Published
2013
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23. Decreased aEEG continuity and baseline variability in the first 48 hours of life associated with poor short-term outcome in neonates born before 29 weeks gestation.

Author

Bowen JR, Paradisis M, and Shah D

Subjects
Female, Gestational Age, Humans, Infant, Extremely Low Birth Weight, Infant, Newborn, Intracranial Hemorrhages mortality, Intracranial Hemorrhages physiopathology, Male, New South Wales, Predictive Value of Tests, Prognosis, Prospective Studies, Sensitivity and Specificity, Severity of Illness Index, Time Factors, Electroencephalography, Infant, Premature, Infant, Very Low Birth Weight, Intracranial Hemorrhages diagnosis, Monitoring, Physiologic methods
Abstract

Amplitude-integrated electroencephalography (aEEG) provides us with a method of assessing brain activity in critically ill neonates. In extremely premature neonates, the aEEG trace is predominantly discontinuous, making it difficult to distinguish between a "normal" and "abnormal" trace. We measured aEEG activity in the first 48 h of life in neonates born before 29-wk gestation and used both visual and quantitative analysis of the aEEG data to assess differences in neonates with poor short-term outcome [death or peri/intraventricular hemorrhage (P/IVH)] compared with those who survived without P/IVH to identify features of an abnormal aEEG. On quantitative analysis, EEG continuity <80% at 10-microV level was a sensitive and specific marker of poor short-term outcome. By using this marker, we identified 83% of neonates who died or developed grade 3 or 4 IVH and 60% of neonates who developed grades 1 or 2 IVH, with a positive predictive value for death or any IVH of 73% and a negative predictive value of 86%. Absence of sleep-wake cycling with baseline variability <2 microV was the strongest predictor of outcome using visual analysis alone.

Published
2010
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24. Duration of indomethacin treatment of the preterm patent ductus arteriosus as directed by echocardiography.

Author

Carmo KB, Evans N, and Paradisis M

Subjects
Drug Administration Schedule, Ductus Arteriosus, Patent surgery, Echocardiography, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases surgery, Male, Pilot Projects, Treatment Outcome, Cyclooxygenase Inhibitors administration & dosage, Ductus Arteriosus, Patent diagnostic imaging, Ductus Arteriosus, Patent drug therapy, Indomethacin administration & dosage, Infant, Premature, Diseases diagnostic imaging, Infant, Premature, Diseases drug therapy
Abstract

Objective: To determine whether the duration of indomethacin administration could be shortened in infants with good early constrictive response of patent ductus arteriosus (PDA)., Study Design: Infants born at< 30 weeks' gestational age were assessed with echocardiography in the first 12 hours of life and treated with indomethacin (0.1 mg/kg) if the PDA was >2 mm in diameter. Randomization occurred before the second dose to either standard treatment (2 more doses of indomethacin at 0.1 mg/kg irrespective of echocardiographic findings) or to echocardiographically directed duration of indomethacin treatment (ECHO; further doses only if the PDA was>1.6 mm). Serial echocardiography was performed to day 28 of age. The primary outcome was failure of PDA closure., Results: The infants were randomized to either the ECHO arm (n=34) or the standard treatment arm (n=40). No differences between the arms were seen in terms of failure of PDA closure, PDA reopening, need for further doses of indomethacin, or need for surgical ligation. More doses of indomethacin were given in the standard treatment arm (median, 3 doses [range, 1 to 12] vs 1 dose [range, 1 to 15]; P < .0001)., Conclusion: Echocardiographically directed duration of indomethacin treatment is effective in achieving PDA closure and offers the potential for dose minimization.

Published
2009
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25. Randomized trial of milrinone versus placebo for prevention of low systemic blood flow in very preterm infants.

Author

Paradisis M, Evans N, Kluckow M, and Osborn D

Subjects
Blood Pressure drug effects, Double-Blind Method, Echocardiography, Female, Heart Rate drug effects, Humans, Infant, Newborn, Infant, Premature, Male, Monitoring, Physiologic, Vena Cava, Superior diagnostic imaging, Cardiac Output, Low prevention & control, Infant, Premature, Diseases prevention & control, Milrinone therapeutic use, Vasodilator Agents therapeutic use
Abstract

Objective: To assess the effectiveness of early prophylactic milrinone versus placebo for prevention of low systemic blood flow in high-risk preterm infants., Study Design: Double-blind randomized placebo controlled trial of milrinone (loading dose 0.75 microg/kg/min for 3 hours then maintenance 0.2 microg/kg/min until 18 hours after birth) versus placebo. Infants born <30 weeks gestational age and <6 hours of age were eligible and were monitored with serial echocardiography, head ultrasound scanning, and continuous invasive blood pressure. Primary outcome was maintenance of superior vena cava (SVC) flow > or =45 mL/kg/min through the first 24 hours. The exit criterion was hypotension unresponsive to volume and inotropes., Results: Ninety infants were enrolled, equal proportions maintained SVC flow > or =45 mL/kg/min after treatment commenced. No significant difference was observed in SVC flow, right ventricular output, and blood pressure during the first 24 hours; or grades 3 to 4 periventricular/intraventricular hemorrhage and death. Heart rate was higher and constriction of the ductus was slower in the infants randomized to milrinone., Conclusions: Milrinone did not prevent low systemic blood flow during the first 24 hours in very preterm infants, and no adverse effects were attributable to milrinone. Use of a preventative treatment with rescue model allowed comparison of an inotrope with placebo in this high-risk group of infants.

Published
2009
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26. The effect of inotropes on morbidity and mortality in preterm infants with low systemic or organ blood flow.

Author

Osborn DA, Paradisis M, and Evans N

Subjects
Dobutamine therapeutic use, Dopamine therapeutic use, Humans, Infant, Newborn, Morbidity, Regional Blood Flow physiology, Blood Circulation physiology, Blood Volume, Cardiotonic Agents therapeutic use, Infant, Premature physiology
Abstract

Background: Low systemic blood flow (SBF) is common in extremely premature infants in the first day after birth and has been associated with peri / intraventricular haemorrhage (PIVH), necrotising enterocolitis (NEC), mortality and developmental impairment., Objectives: To determine the effect of specific inotropes on morbidity and mortality in preterm infants with low systemic blood flow, Search Strategy: Searches were made of The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006 ), MEDLINE (1966 - April 2006), EMBASE (1980 - April 2006) and CINAHL (1982 - April 2006), supplemented by searches of abstracts of conference proceedings, citations of reviews and expert informants., Selection Criteria: Random and quasi-random controlled trials of inotropes enrolling preterm infants with low systemic or organ blood flow in the neonatal period., Data Collection and Analysis: Independent assessment of trial eligibility, quality and data extraction by each review author. Synthesis of data using relative risk (RR) and weighted mean difference (WMD) using standard methods of the Cochrane Collaboration., Main Results: No studies that compared an inotrope to no treatment in preterm infants with low SBF were found. One study (Osborn 2002a) was found that compared dobutamine versus dopamine. The study was of adequate methodology. It enrolled 42 infants < 30 weeks gestation and < 12 hours after birth with low SVC flow. The trial compared the effect of dobutamine versus dopamine titrated 10 to 20 mug/kg/min with the goal of increasing and maintaining SVC flow > 40 ml/kg/min. No significant difference was reported in mortality to discharge (RR 1.41, 95% CI 0.79, 2.52), PIVH (RR 1.01, 95% 0.52, 1.97), grade 3 or 4 PIVH (RR 0.39, 95% CI 0.12, 1.31) or NEC. At three years, there was no significant difference in cerebral palsy, deafness, Developmental quotient > 2 sd below norm or combined disability (RR 0.10, 95% CI 0.01, 1.56). Surviving infants treated with dobutamine had a significantly higher development quotient (MD 35.00, 95% CI 17.68, 52.32). There was no significant difference in death or disability at the latest time reported (RR 0.95, 95% CI 0.66, 1.38). For secondary outcomes, there was no significant difference in periventricular leucomalacia, renal impairment, pulmonary haemorrhage, retinopathy of prematurity or CLD at 36 weeks. There was no significant difference in treatment failure. Dobutamine produced a significantly greater increase in SVC flow at the highest dose reached (MD 13.10, 95% CI 2.87, 23.33), whereas dopamine produced a significantly greater increase in mean BP at 10 and 20 mug/kg/min and at the highest dose reached (MD -7.20, 95% CI -11.41, -2.99)., Authors' Conclusions: In preterm infants with low systemic blood flow, there is some evidence that dobutamine is better than dopamine at increasing and maintaining systemic blood flow. The only eligible trial did not demonstrate any consistent differences in clinical outcomes. However, this study was not sufficiently powered to prove or disprove effects on clinical outcomes. It is unclear what is the most effective strategy for improving the cardiovascular status of immature infants in the first day. Further trials are needed to determine effective strategies for preventing and improving low systemic and organ blood flow.

Published
2007
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27. Pilot study of milrinone for low systemic blood flow in very preterm infants.

Author

Paradisis M, Evans N, Kluckow M, Osborn D, and McLachlan AJ

Subjects
Cerebral Hemorrhage diagnostic imaging, Dose-Response Relationship, Drug, Female, Hemodynamics, Humans, Infant, Newborn, Infant, Premature, Infusions, Intra-Arterial, Male, Milrinone blood, Milrinone pharmacokinetics, Monitoring, Physiologic, Pilot Projects, Prospective Studies, Survival Analysis, Ultrasonography, Vasodilator Agents blood, Vasodilator Agents pharmacokinetics, Cardiac Output, Low prevention & control, Infant, Premature, Diseases prevention & control, Milrinone administration & dosage, Vasodilator Agents administration & dosage
Abstract

Objectives: To examine the hemodynamic effects of milrinone given prophylactically to very preterm infants at high risk of low superior vena cava (SVC) flow and to investigate the preliminary efficacy and safety of an optimal dose., Study Design: This was a prospective, open-label study in two stages. The first involved dose escalation in two cohorts. Milrinone infusions of 0.25 microg/kg per minute (n = 8) and then 0.5 microg/kg per minute (n = 11) were administered from 3 to 24 hours of age. Population pharmacokinetic modeling was used to develop an optimized dose regimen. Ten infants then were loaded with 0.75 microg/kg per minute for 3 hours, followed by 0.2 microg/kg per minute maintenance until 18 hours of age. Infants were monitored for blood pressure, serial echocardiograms, and blood milrinone levels. The primary outcome was maintenance of SVC flow greater than 45 mL/kg per minute through the first 24 hours., Results: Low SVC flow developed in 36% of babies at both 0.25 microg/kg per minute and 0.5 microg/kg per minute of milrinone. Blood levels on these two regimens were slow to reach the target range and accumulated above this range by 24 hours. At 0.75 to 0.2 microg/kg per minute, no infant had SVC flow below 45 mL/kg per minute, compared with 61% in historic control subjects. Four infants needed an additional inotrope to support blood pressure. Blood levels were within the target range in 9 of 10 babies., Conclusions: We used population pharmacokinetic modeling to develop an optimal dosing regimen for milrinone. The efficacy and safety in this novel preventative approach to circulatory support is encouraging but inconclusive. We do not recommend the use of milrinone in preterm infants outside a research setting.

Published
2006
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28. Adrenaline for prevention of morbidity and mortality in preterm infants with cardiovascular compromise.

Author

Paradisis M and Osborn DA

Subjects
Dopamine therapeutic use, Heart Rate drug effects, Humans, Infant, Newborn, Infant, Premature, Randomized Controlled Trials as Topic, Cardiotonic Agents therapeutic use, Epinephrine therapeutic use, Hypotension drug therapy, Infant, Premature, Diseases drug therapy
Abstract

Background: Inotropes are widely used in preterm infants to treat cardiovascular compromise, which may result from early adaptive problems of the transitional circulation, perinatal asphyxia or sepsis. Sustained hypotension and poor organ blood flow are associated with brain injury including peri/intraventricular haemorrhage and subsequent poor neurodevelopmental outcomes. Adrenaline (epinephrine) infusions are used in preterm infants with clinical cardiovascular compromise., Objectives: To determine the effectiveness and safety of adrenaline compared to no treatment or other inotropes in reducing mortality and morbidity in preterm infants with cardiovascular compromise., Search Strategy: Randomised controlled trials were identified by searching MEDLINE (1966-August 2003), The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2003) and EMBASE (1980 - 2003), supplemented with searches of reference lists of published trials and abstracts of conference proceedings., Selection Criteria: Randomised controlled trials of preterm newborn infants that compared adrenaline to no treatment or other inotropic agents (including dopamine, dobutamine, noradrenaline or isoprenaline)., Data Collection and Analysis: Data were extracted and analysed independently by two reviewers. Treatment effects on the following outcomes were to be determined: mortality in the newborn period, long term neurodevelopmental outcomes, radiological evidence of brain injury, short term haemodynamic changes, adverse drug effects and short term neonatal outcomes. Study authors were contacted for additional information. Studies were analysed for methodological quality using the criteria of the Cochrane Neonatal Review Group., Main Results: One ongoing study (Pellicer 2003) was identified. One study comparing adrenaline with dopamine infusion was included but was published in abstract form only (Phillipos 1996). It enrolled hypotensive, predominantly preterm infants in the first 24 hours. Only infants >1750g are included in this review (report for infants <=1750g appears incomplete). The study was reported as being randomised and double blinded, but methods were not reported. Both adrenaline and dopamine significantly increased heart rate and mean BP, with no statistically significant effect on left or right ventricular outputs. No other clinical outcomes were reported. No studies were identified that compared adrenaline to other inotropes, placebo or no treatment., Reviewer's Conclusions: There are insufficient data on the use of adrenaline infusions in preterm infants with cardiovascular compromise to make recommendations for practice. There is a need for larger trials to determine whether adrenaline is effective in reducing morbidity and mortality in preterm infants with cardiovascular compromise.

Published
2004
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30. Induction toxicity in childhood acute lymphoblastic leukemia: a comparison of two schedules of daunorubicin administration.

Author

Shaw PJ, Eden T, and Paradisis M

Subjects
Child, Child, Preschool, Daunorubicin administration & dosage, Female, Fever chemically induced, Humans, Infant, Male, Retrospective Studies, Daunorubicin adverse effects, Leukemia, Lymphoid drug therapy, Neutropenia chemically induced, Thrombocytopenia chemically induced
Abstract

The haematological toxicity of the induction phase of chemotherapy for acute lymphoblastic leukaemia (ALL) was compared in two cohorts of patients. The principal difference between these two cohorts was the mode of administration of the anthracycline, daunorubicin (DNR). Both groups received four-drug induction chemotherapy, which produced a high remission rate. Those receiving DNR on days 1 and 2 experienced a profound but shorter period of neutropenia and more severe thrombocytopenia than those who received the DNR weekly. The pattern of hospitalisation and support facilities in the individual unit may determine which regimen is to be preferred. These observations are relevant for the newly diagnosed patient in whom an anthracycline is retained in the induction therapy for ALL.

Published
1995
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