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2. 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

9. 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

10. STRIDER (Sildenafil TheRapy in dismal prognosis early onset fetal growth restriction): An international consortium of randomised placebo-controlled trials

Author

Pels, A, Kenny, LC, Alfirevic, Z, Baker, PN, von Dadelszen, P, Gluud, C, Kariya, CT, Mol, BW, Papageorghiou, A, van Wassenaer-Leemhuis, AG, Ganzevoort, W, Groom, KM, McCowan, LM, Stone, PR, Lee, A, Mackay, L, Oyston, C, Gardener, G, Khashan, A, Eustace, J, Dempsey, E, Jackson, R, Dickinson, J, Gill, A, Muller, P, Sekar, R, Reid, RA, Unterschneider, J, Welsh, A, Marlow, J, Hyett, J, Walker, S, Morris, J, Watson, D, McKinlay, C, Harris, S, Lim, KI, Lalji, S, Magee, LA, Lee, T, Li, J, Hutfield, A, Ansermino, M, Robinson, W, Singer, J, Synnes, AR, Burrows, J, Audibert, F, Bujold, E, Piedboeuf, B, Davidge, ST, Seaward, GR, Dwinnell, S, Gagnon, R, Gaudet, L, Young, C, Murphy, D, Daly, S, McAuliffe, F, Malone, F, Breathnach, F, O'Donoghue, K, Al-Nasiry, S, de Boer, MA, de Groot, CJM, Sueters, M, Derks, JB, van Drongelen, J, Duvekot, HJ, Elvan-Taspinar, A, van Eyck, J, van Laar, J, Morssink, LP, Price, L, Astor, A, Hardman, L, Sharp, A, Turner, M, Cameron, A, Draper, E, Clarke, P, Mckelvey, A, Masson, G, Aquilin, J, Johnstone, E, Bugg, G, Howe, D, Patni, S, Mousa, H, Russell, H, Hannon, T, Kilby, M, David, A, Cohen, K, Impey, L, Stock, S, Poon, L, Pasupath, D, Khalil, A, Pels, A, Kenny, LC, Alfirevic, Z, Baker, PN, von Dadelszen, P, Gluud, C, Kariya, CT, Mol, BW, Papageorghiou, A, van Wassenaer-Leemhuis, AG, Ganzevoort, W, Groom, KM, McCowan, LM, Stone, PR, Lee, A, Mackay, L, Oyston, C, Gardener, G, Khashan, A, Eustace, J, Dempsey, E, Jackson, R, Dickinson, J, Gill, A, Muller, P, Sekar, R, Reid, RA, Unterschneider, J, Welsh, A, Marlow, J, Hyett, J, Walker, S, Morris, J, Watson, D, McKinlay, C, Harris, S, Lim, KI, Lalji, S, Magee, LA, Lee, T, Li, J, Hutfield, A, Ansermino, M, Robinson, W, Singer, J, Synnes, AR, Burrows, J, Audibert, F, Bujold, E, Piedboeuf, B, Davidge, ST, Seaward, GR, Dwinnell, S, Gagnon, R, Gaudet, L, Young, C, Murphy, D, Daly, S, McAuliffe, F, Malone, F, Breathnach, F, O'Donoghue, K, Al-Nasiry, S, de Boer, MA, de Groot, CJM, Sueters, M, Derks, JB, van Drongelen, J, Duvekot, HJ, Elvan-Taspinar, A, van Eyck, J, van Laar, J, Morssink, LP, Price, L, Astor, A, Hardman, L, Sharp, A, Turner, M, Cameron, A, Draper, E, Clarke, P, Mckelvey, A, Masson, G, Aquilin, J, Johnstone, E, Bugg, G, Howe, D, Patni, S, Mousa, H, Russell, H, Hannon, T, Kilby, M, David, A, Cohen, K, Impey, L, Stock, S, Poon, L, Pasupath, D, and Khalil, A

Abstract

Background: Severe, early-onset fetal growth restriction due to placental insufficiency is associated with a high risk of perinatal mortality and morbidity with long-lasting sequelae. Placental insufficiency is the result of abnormal formation and function of the placenta with inadequate remodelling of the maternal spiral arteries. There is currently no effective therapy available. Some evidence suggests sildenafil citrate may improve uteroplacental blood flow, fetal growth, and meaningful infant outcomes. The objective of the Sildenafil TheRapy In Dismal prognosis Early onset fetal growth Restriction (STRIDER) collaboration is to evaluate the effectiveness of sildenafil versus placebo in achieving healthy perinatal survival through the conduct of randomised clinical trials and systematic review including individual patient data meta-analysis. Methods: Five national/bi-national multicentre randomised placebo-controlled trials have been launched. Women with a singleton pregnancy between 18 and 30 weeks with severe fetal growth restriction of likely placental origin, and where the likelihood of perinatal death/severe morbidity is estimated to be significant are included. Participants will receive either sildenafil 25 mg or matching placebo tablets orally three times daily from recruitment to 32 weeks gestation. Discussion: The STRIDER trials were conceived and designed through international collaboration. Although the individual trials have different primary outcomes for reasons of sample size and feasibility, all trials will collect a standard set of outcomes including survival without severe neonatal morbidity at time of hospital discharge. This is a summary of all the STRIDER trial protocols and provides an example of a prospectively planned international clinical research collaboration. All five individual trials will contribute to a pre-planned systematic review of the topic including individual patient data meta-analysis.

Published
2017

11. STRIDER (Sildenafil TheRapy in dismal prognosis early onset fetal growth restriction): An international consortium of randomised placebo-controlled trials

Author

Pels, A. (A.), Kenny, L.C. (Louise C.), Alfirevic, Z. (Zarko), Baker, P.N. (Philip Newton), Dadelszen, P. (Peter) von, Gluud, C. (Christian), Kariya, C.T. (C. T.), Mol, B.W.J. (Ben), Papageorghiou, A. (A.), Wassenaer-Leemhuis, A.G. (Aleid) van, Ganzevoort, W. (Wessel), Groom, K.M. (K. M.), McCowan, L.M. (L. M.), Stone, P.R. (P. R.), Lee, A. (A.), Mackay, L. (L.), Oyston, C. (C.), Gardener, G. (G.), Khashan, A. (A.), Eustace, J. (J.), Dempsey, E. (E.), Jackson, R. (R.), Dickinson, J. (J.), Gill, A. (A.), Muller, P. (P.), Sekar, R. (R.), Reid, R.A. (R. A.), Unterschneider, J. (J.), Welsh, A. (A.), Marlow, J. (J.), Hyett, J. (Jon), Walker, S. (S.), Morris, J., Watson, D. (D.), McKinlay, C. (C.), Harris, S. (S.), von Dadelszen, P. (P.), Lim, K.I. (K. I.), Lalji, S. (S.), Magee, L.A. (L. A.), Lee, T. (T.), Li, J. (J.), Hutfield, A. (A.), Ansermino, M. (M.), Robinson, W. (W.), Singer, J. (J.), Synnes, A.R. (A. R.), Burrows, J. (J.), Audibert, F. (F.), Bujold, E. (Emmanuel), Piedboeuf, B. (B.), Davidge, S.T. (S. T.), Seaward, G.R. (G. R.), Dwinnell, S. (S.), Gagnon, R. (R.), Gaudet, L. (L.), Young, C. (C.), Murphy, D. (D.), Daly, S. (S.), McAuliffe, F. (F.), Malone, F. (F.), Breathnach, F. (F.), O'Donoghue, K. (K.), Ganzevoort, J.W. (J. W.), Al-Nasiry, S. (S.), de Boer, M.A. (M. A.), Groot, C.J.M. (Christianne) de, Sueters, M. (M.), Derks, J.B. (Jan), van Drongelen, J. (J.), Duvekot, J.J. (Hans), Elvan-Taspinar, A. (A.), Eyck, J. (Jim) van, van Laar, J. (J.), Morssink, L.P. (L. P.), Alfirevic, Z. (Z.), Price, L. (L.), Astor, A. (A.), Hardman, L. (L.), Sharp, A. (A.), Turner, M. (M.), Cameron, A. (A.), Draper, E. (E.), Clarke, P. (P.), Mckelvey, A. (A.), Papageorghiou, A.T. (A.), Masson, G. (G.), Aquilin, J. (J.), Johnstone, E. (E.), Bugg, G. (G.), Howe, D. (D.), Patni, S. (S.), Mousa, H. (H.), Russell, H. (H.), Hannon, T. (T.), Kilby, M.D. (Mark), David, A. (A.), Cohen, K. (K.), Impey, L. (L.), Stock, S. (S.), Poon, L. (L.), Pasupath, D. (D.), Khalil, A. (Asma), Baker, P.N. (P. N.), Pels, A. (A.), Kenny, L.C. (Louise C.), Alfirevic, Z. (Zarko), Baker, P.N. (Philip Newton), Dadelszen, P. (Peter) von, Gluud, C. (Christian), Kariya, C.T. (C. T.), Mol, B.W.J. (Ben), Papageorghiou, A. (A.), Wassenaer-Leemhuis, A.G. (Aleid) van, Ganzevoort, W. (Wessel), Groom, K.M. (K. M.), McCowan, L.M. (L. M.), Stone, P.R. (P. R.), Lee, A. (A.), Mackay, L. (L.), Oyston, C. (C.), Gardener, G. (G.), Khashan, A. (A.), Eustace, J. (J.), Dempsey, E. (E.), Jackson, R. (R.), Dickinson, J. (J.), Gill, A. (A.), Muller, P. (P.), Sekar, R. (R.), Reid, R.A. (R. A.), Unterschneider, J. (J.), Welsh, A. (A.), Marlow, J. (J.), Hyett, J. (Jon), Walker, S. (S.), Morris, J., Watson, D. (D.), McKinlay, C. (C.), Harris, S. (S.), von Dadelszen, P. (P.), Lim, K.I. (K. I.), Lalji, S. (S.), Magee, L.A. (L. A.), Lee, T. (T.), Li, J. (J.), Hutfield, A. (A.), Ansermino, M. (M.), Robinson, W. (W.), Singer, J. (J.), Synnes, A.R. (A. R.), Burrows, J. (J.), Audibert, F. (F.), Bujold, E. (Emmanuel), Piedboeuf, B. (B.), Davidge, S.T. (S. T.), Seaward, G.R. (G. R.), Dwinnell, S. (S.), Gagnon, R. (R.), Gaudet, L. (L.), Young, C. (C.), Murphy, D. (D.), Daly, S. (S.), McAuliffe, F. (F.), Malone, F. (F.), Breathnach, F. (F.), O'Donoghue, K. (K.), Ganzevoort, J.W. (J. W.), Al-Nasiry, S. (S.), de Boer, M.A. (M. A.), Groot, C.J.M. (Christianne) de, Sueters, M. (M.), Derks, J.B. (Jan), van Drongelen, J. (J.), Duvekot, J.J. (Hans), Elvan-Taspinar, A. (A.), Eyck, J. (Jim) van, van Laar, J. (J.), Morssink, L.P. (L. P.), Alfirevic, Z. (Z.), Price, L. (L.), Astor, A. (A.), Hardman, L. (L.), Sharp, A. (A.), Turner, M. (M.), Cameron, A. (A.), Draper, E. (E.), Clarke, P. (P.), Mckelvey, A. (A.), Papageorghiou, A.T. (A.), Masson, G. (G.), Aquilin, J. (J.), Johnstone, E. (E.), Bugg, G. (G.), Howe, D. (D.), Patni, S. (S.), Mousa, H. (H.), Russell, H. (H.), Hannon, T. (T.), Kilby, M.D. (Mark), David, A. (A.), Cohen, K. (K.), Impey, L. (L.), Stock, S. (S.), Poon, L. (L.), Pasupath, D. (D.), Khalil, A. (Asma), and Baker, P.N. (P. N.)

Abstract

Background: Severe, early-onset fetal growth restriction due to placental insufficiency is associated with a high risk of perinatal mortality and morbidity with long-lasting sequelae. Placental insufficiency is the result of abnormal formation and function of the placenta with inadequate remodelling of the maternal spiral arteries. There is currently no effective therapy available. Some evidence suggests sildenafil citrate may improve uteroplacental blood flow, fetal growth, and meaningful infant outcomes. The objective of the Sildenafil TheRapy In Dismal prognosis Early onset fetal growth Restriction (STRIDER) collaboration is to evaluate the effectiveness of sildenafil versus placebo in achieving healthy perinatal survival through the conduct of randomised clinical trials and systematic review including individual patient data meta-analysis. Methods: Five national/bi-national multicentre randomised placebo-controlled trials have been launched. Women with a singleton pregnancy between 18 and 30 weeks with severe fetal growth restriction of likely placental origin, and where the likelihood of perinatal death/severe morbidity is estimated to be significant are included. Participants will receive either sildenafil 25 mg or matching placebo tablets orally three times daily from recruitment to 32 weeks gestation. Discussion: The STRIDER trials were conceived and designed through international collaboration. Although the individual trials have different primary outcomes for reasons of sample size and feasibility, all trials will collect a standard set of outcomes including survival without severe neonatal morbidity at time of hospital discharge. This is a summary of all the STRIDER trial protocols and provides an example of a prospectively planned international clinical research collaboration. All five individual trials will contribute to a pre-planned systematic review of the topic including individual patient data meta-analysis.

Published
2017
Full Text
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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

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

15. The Canadian Perinatal Network: a national network focused on threatened preterm birth at 22 to 28 weeks' gestation

Author

La, Magee, von Dadelszen P, Vm, Allen, J Mark Ansermino, Audibert F, Barrett J, Brant R, Bujold E, Jm, Crane, Demianczuk N, Ks, Joseph, Sk, Lee, Piedboeuf B, Smith G, Synnes A, Walker M, Whittle W, Wood S, Lee T, Li J, Payne B, Rm, Liston, and Canadian Perinatal Network Collaborative Group

Abstract

OBJECTIVE: The Canadian Perinatal Network (CPN) maintains an ongoing national database focused on threatened very preterm birth. The objective of the network is to facilitate between-hospital comparisons and other research that will lead to reductions in the burden of illness associated with very preterm birth. METHODS: Women were included in the database if they were admitted to a participating tertiary perinatal unit at 22+0 to 28+6 weeks' gestation with one or more conditions most commonly responsible for very preterm birth, including spontaneous preterm labour with contractions, incompetent cervix, prolapsing membranes, preterm prelabour rupture of membranes, gestational hypertension, intrauterine growth restriction, or antepartum hemorrhage. Data were collected by review of maternal and infant charts, entered directly into standardized electronic data forms and uploaded to the CPN via a secure network. RESULTS: Between 2005 and 2009, the CPN enrolled 2524 women from 14 hospitals including those with preterm labour and contractions (27.4%), short cervix without contractions (16.3%), prolapsing membranes (9.4%), antepartum hemorrhage (26.1%), and preterm prelabour rupture of membranes (23.0%). The mean gestational age at enrolment was 25.9 ± 1.9 weeks and the mean gestation age at delivery was 29.9 ± 5.1 weeks; 57.0% delivered at < 29 weeks and 75.4% at < 34 weeks. Complication rates were high and included serious maternal complications (26.7%), stillbirth (8.2%), neonatal death (16.3%), neonatal intensive care unit admission (60.7%), and serious neonatal morbidity (35.0%). CONCLUSION: This national dataset contains detailed information about women at risk of very preterm birth. It is available to clinicians and researchers who are working with one or more CPN collaborators and who are interested in studies relating processes of care to maternal or perinatal outcomes.

Published
2011

19. Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants

Author

Beltempo, M, Lacroix, G, Cabot, M, Blais, R, and Piedboeuf, B

Abstract

Objective:To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants.Study design:Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight <1000 g admitted at a 56 bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity).Results:Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99).Conclusion:High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.

Published
2018
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20. Induction of metallothionein and heme oxygenase in rats after inhalation of endotoxin

Author

Greg Cosma, Squibb K, Hur T, Piedboeuf B, Darlene Bowser, Terry Gordon, and Horowitz S

Subjects
Lipopolysaccharides, medicine.medical_specialty, Lipopolysaccharide, Health, Toxicology and Mutagenesis, In situ hybridization, Biology, Toxicology, medicine.disease_cause, chemistry.chemical_compound, Mice, Internal medicine, Gene expression, medicine, Metalloprotein, Metallothionein, Animals, RNA, Messenger, Lung, In Situ Hybridization, chemistry.chemical_classification, Inhalation Exposure, Rats, Inbred F344, Rats, Heme oxygenase, Zinc, Endocrinology, chemistry, Biochemistry, Liver, Enzyme Induction, Toxicity, Heme Oxygenase (Decyclizing), Oxidative stress, Copper
Abstract

Various stress proteins appear to play a role in injury and repair produced by inhaled pollutants. The present study examined the effect of inhaled endotoxin on the expression of the metallothionein and heme oxygenase genes. Rats were exposed to saline or endotoxin aerosols for 3 h and sacrificed up to 3 d following exposure. The significant induction of metallothionein mRNA in both the lung (fourfold increase) and liver (one-fold) were greatest at 3 h and returned to basal levels by 24 h after endotoxin exposure. Similarly, the increase in tissue metallothionein was greater in the lung. In situ hybridization in mice showed large increases in the relative abundance of metallothionein transcripts in epithelial cells of the conducting airways, in surrounding airway tissue, and in the nearby gas exchange region. While an endotoxin-induced significant increase in heme oxygenase mRNA followed a time course similar to that observed for metallo thionein, the relative magnitude was reversed for the lung and liver. Heme oxygenase mRNA was induced greater in the liver (twofold) than in the lung (60% above control). Our findings demonstrate that metallothionein and heme oxygenase are early response genes that are rapidly activated after inhalation of occupationally relevant concentrations of endotoxin.

Published
1999

24. Association between birth route and late-onset sepsis in very preterm neonates

Author

Olivier, F, Bertelle, V, Shah, P S, Drolet, C, and Piedboeuf, B

Abstract

Objective:: To evaluate the association between birth route and late-onset sepsis (LOS), and coagulase-negative Staphylococcal (CONS)-related LOS in preterm neonates. Study Design:: In this observational study, data from 20,038 infants born between 22 and 32 weeks’ gestation and admitted to Canadian neonatal intensive care units between 2010 and 2014 were analyzed retrospectively. The impact of birth route on LOS was assessed using univariate analysis and multiple logistic regression. Results:: A total of 8218 neonates were born via vaginal route and 11,820 via cesarean section. Incidence rates of LOS for infants born vaginally and via a cesarean section were 13.1 and 13.2%, respectively, and there was no significant difference in odds of LOS between the groups (adjusted odds ratio (AOR): 0.99; 95% CI 0.87 to 1.12); however, the odds of CONS sepsis were higher in the cesarean group (AOR: 1.15; 95% CI: 1.01 to 1.32). Conclusion:: Birth route did not have an impact on LOS, but was associated with CONS-related LOS.

Published
2016
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28. Surfactant levels after reversible tracheal occlusion and prenatal steroids in experimental diaphragmatic hernia

Author

Bratu, I., Flageole, H., Laberge, J.M., Possmayer, F., Harbottle, R., Kay, S., Khalife, S., and Piedboeuf, B.

Abstract

Background/Purpose:: In normal lungs, fetal tracheal occlusion (TO) induces lung growth but decreases the number of type II cells; this is remedied if TO is released (TR) before delivery. In the current study, the effects of TO with or without TR on pulmonary structure and surfactant were assessed in the ovine model in which lung hypoplasia was induced by creation of a diaphragmatic hernia (CDH). Methods:: A left-sided CDH was created in fetal lambs at 80 days gestation; TO was done at 108 days; and TR at 129 days. All ewes were given 1 dose of glucocorticoids at 135 days. At 136 days, the fetus was delivered. Lung weight to body weight ratio, mean terminal bronchiole density, type II cell density, bronchoalveolar lavage fluid (BAL) phosphatidylcholine (PC), BAL surfactant protein A (SP-A) and B (SP-13), and lung tissue SP-A and SP-13 were assessed in CDH, CDH with TO, CDH with TO and TR, and controls. Results:: CDH lungs were hypoplastic and structurally immature, but had increased type II cell density. TO with or without TR caused lung growth with normalization of lung parenchymal architecture and type II cell density. Although the BAL SP-A and BAL SP-13 were similar in all 4 groups, the BAL PC was low in CDH with or without TO or TR. Also, lung tissue SP-13 levels were low in CDH with or without TO or TR. However, lung tissue SP-A levels were normal in CDH, but low in CDH with TO with or without TR. Conclusions:: Despite the finding that lung morphology was improved in CDH with TO with or without TR animals, surfactant content and composition remained abnormal. Although surfactant secreted early by the fetus into alveolar spaces contained normal levels of BAL SP-A and BAL SP-B, the low levels of BAL PC and low lung tissue stores of SP-13 indicate that these experimental lambs may experience respiratory insufficiency soon after birth. This implies that prophylactic surfactant at birth might be beneficial for CDH.

Published
2001
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31. 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 (

32. An international trial of antioxidants in the prevention of preeclampsia (INTAPP)

Author

Xu H, Perez-Cuevas R, Xiong X, Reyes H, Roy C, Julien P, Smith G, von Dadelszen P, Leduc L, Audibert F, Moutquin JM, Piedboeuf B, Shatenstein B, Parra-Cabrera S, Choquette P, Winsor S, Wood S, Benjamin A, Walker M, and Helewa M

Abstract

OBJECTIVE: We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. STUDY DESIGN: In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. RESULTS: Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. CONCLUSION: Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes. [ABSTRACT FROM AUTHOR]

Published
2010
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38. Association of Shift-Level Organizational Factors with Nosocomial Infection in the Neonatal Intensive Care Unit.

Author

Fazio M, Jabbour E, Patel S, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B, and Beltempo M

Abstract

Objective: To evaluate the association between shift-level organizational data (unit occupancy, nursing overtime ratios [OTRs], and nursing provision ratios [NPRs]) with nosocomial infection (NI) among infants born very preterm in the neonatal intensive care unit (NICU)., Study Design: This was a multicenter, retrospective cohort study, including 1921 infants 23 0/7 -32 6/7  weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant., Results: Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses., Conclusions: Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality., Competing Interests: This project was funded by an Early Career Investigator Grant from the 10.13039/501100000024Canadian Institutes of Health Research (CIHR) Institute of Human Development, Child, and Youth Health (10.13039/501100000031IHDCYH) and an Early Career Investigator Grant from the Montreal Children’s Hospital Foundation. M.B. holds a FRSQ Clinical Research Scholar Career Award Junior 1 and funding from the Ministry of Health of Quebec. The Canadian Neonatal Network is supported by a grant from the CIHR funding the Canadian Preterm Birth Network (PBN 150642). The funding agencies had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors report no conflicts of interest., (© 2024 The Author(s).)

Published
2024
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39. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial.

Author

Chaillet N, Mâsse B, Grobman WA, Shorten A, Gauthier R, Rozenberg P, Dugas M, Pasquier JC, Audibert F, Abenhaim HA, Demers S, Piedboeuf B, Fraser WD, Gagnon R, Gagné GP, Francoeur D, Girard I, Duperron L, Bédard MJ, Johri M, Dubé E, Blouin S, Ducruet T, Girard M, and Bujold E

Subjects
Pregnancy, Female, Humans, Canada, Cesarean Section adverse effects, Delivery, Obstetric adverse effects, Morbidity, Uterine Rupture epidemiology, Uterine Rupture etiology, Uterine Rupture prevention & control
Abstract

Background: Women with a previous caesarean delivery face a difficult choice in their next pregnancy: planning another caesarean or attempting vaginal delivery, both of which are associated with potential maternal and perinatal complications. This trial aimed to assess whether a multifaceted intervention, which promoted person-centred decision making and best practices, would reduce the risk of major perinatal morbidity among women with one previous caesarean delivery., Methods: We conducted an open, multicentre, cluster-randomised, controlled trial of a multifaceted 2-year intervention in 40 hospitals in Quebec among women with one previous caesarean delivery, in which hospitals were the units of randomisation and women the units of analysis. Randomisation was stratified according to level of care, using blocked randomisation. Hospitals were randomly assigned (1:1) to the intervention group (implementation of best practices and provision of tools that aimed to support decision making about mode of delivery, including an estimation of the probability of vaginal delivery and an ultrasound estimation of the risk of uterine rupture), or the control group (no intervention). The primary outcome was a composite risk of major perinatal morbidity. This trial was registered with ISRCTN, ISRCTN15346559., Findings: 21 281 eligible women delivered during the study period, from April 1, 2016 to Dec 13, 2019 (10 514 in the intervention group and 10 767 in the control group). None were lost to follow-up. There was a significant reduction in the rate of major perinatal morbidity from the baseline period to the intervention period in the intervention group as compared with the control group (adjusted odds ratio [OR] for incremental change over time, 0·72 [95% CI 0·52-0·99]; p=0·042; adjusted risk difference -1·2% [95% CI -2·0 to -0·1]). Major maternal morbidity was significantly reduced in the intervention group as compared with the control group (adjusted OR 0·54 [95% CI 0·33-0·89]; p=0·016). Minor perinatal and maternal morbidity, caesarean delivery, and uterine rupture rates did not differ significantly between groups., Interpretation: A multifaceted intervention supporting women in their choice of mode of delivery and promoting best practices resulted in a significant reduction in rates of major perinatal and maternal morbidity, without an increase in the rate of caesarean or uterine rupture., Funding: Canadian Institutes of Health Research (CIHR, MOP-142448)., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Published
2024
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40. Neonatal and Early Childhood Outcomes of Twin and Singleton Infants Born Preterm.

Author

Melamed N, Weitzner O, Church P, Banihani R, Barrett J, Yang J, Wong J, Piedboeuf B, and Shah PS

Subjects
Child, Preschool, Pregnancy, Infant, Newborn, Female, Infant, Humans, Retrospective Studies, Canada epidemiology, Twins, Pregnancy, Twin
Abstract

Objective: To compare neonatal and early-childhood outcomes of twins and singletons born preterm and explore the association of chorionicity with outcomes., Study Design: This was a national retrospective cohort study of singleton and twin infants admitted at 23 0/7 -28 6/7 weeks to level III neonatal intensive care units in Canada (2010-2020). The primary neonatal outcome was a composite of neonatal death or severe neonatal morbidities. The primary early-childhood outcome was a composite of death or significant neurodevelopmental impairment., Results: The study cohort included 3554 twin and 12 815 singleton infants. Twin infants born at 23 0/7 -25 6/7  weeks had a greater risk of the composite neonatal outcome (adjusted risk ratio 1.04, 95% CI 1.01-1.07). However, these differences were limited to the subgroups of same-sex and monochorionic twin pregnancies. Twin infants of 23 0/7 -25 6/7  weeks were also at an increased risk of the composite early-childhood outcome (adjusted risk ratio 1.22, 95% CI 1.09-1.37). Twin infants of 26 0/7 -28 6/7  weeks were not at an increased risk of adverse neonatal outcomes or the composite early-childhood outcome compared with singleton infants., Conclusions: Among infants born at 23 0/7 -25 6/7  weeks, twins have a greater risk of adverse neonatal outcomes and the composite early-childhood outcome than singleton infants. However, the increased risk of adverse neonatal outcomes is mostly limited to monochorionic twins and may thus be driven by complications related to monochorionic placentation., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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41. Association of nurse staffing and unit occupancy with mortality and morbidity among very preterm infants: a multicentre study.

Author

Beltempo M, Patel S, Platt RW, Julien AS, Blais R, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, and Piedboeuf B

Subjects
Infant, Infant, Newborn, Humans, Retrospective Studies, Infant Mortality, Morbidity, Intensive Care Units, Neonatal, Workforce, Infant, Premature, Infant, Premature, Diseases
Abstract

Objective: In a healthcare system with finite resources, hospital organisational factors may contribute to patient outcomes. We aimed to assess the association of nurse staffing and neonatal intensive care unit (NICU) occupancy with outcomes of preterm infants born <33 weeks' gestation., Design: Retrospective cohort study., Setting: Four level III NICUs., Patients: Infants born 23-32 weeks' gestation 2015-2018., Main Outcome Measures: Nursing provision ratios (nursing hours worked/recommended nursing hours based on patient acuity categories) and unit occupancy rates were averaged for the first shift, 24 hours and 7 days of admission of each infant. Primary outcome was mortality/morbidity (bronchopulmonary dysplasia, severe neurological injury, retinopathy of prematurity, necrotising enterocolitis and nosocomial infection). ORs for association of exposure with outcomes were estimated using generalised linear mixed models adjusted for confounders., Results: Among 1870 included infants, 823 (44%) had mortality/morbidity. Median nursing provision ratio was 1.03 (IQR 0.89-1.22) and median unit occupancy was 89% (IQR 82-94). In the first 24 hours of admission, higher nursing provision ratio was associated with lower odds of mortality/morbidity (OR 0.93, 95% CI 0.89 to 0.98), and higher unit occupancy was associated with higher odds of mortality/morbidity (OR 1.19, 95% CI 1.04 to 1.36). In causal mediation analysis, nursing provision ratios mediated 47% of the association between occupancy and outcomes., Conclusions: NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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42. Neonatal intensive care unit occupancy rate and probability of discharge of very preterm infants.

Author

Beltempo M, Sargi E, Patel S, Lacroix G, Lapointe A, Taylor-Ducharme S, Morin S, Bizgu V, and Piedboeuf B

Subjects
Infant, Infant, Newborn, Humans, Patient Discharge, Infant, Premature, Retrospective Studies, Gestational Age, Probability, Intensive Care Units, Neonatal, Infant, Premature, Diseases
Abstract

Objective: To assess the association of NICU occupancy with probability of discharge and length of stay (LOS) among infants born <33 weeks gestational age (GA)., Study Design: Retrospective study of 3388 infants born 23-32 weeks GA, admitted to five Level 3/4 NICUs (2014-2018) and discharged alive. Standardized ratios of observed-to-expected number of discharges were calculated for each quintile of unit occupancy. Multivariable linear regression models were used to assess the association between occupancy and LOS., Results: At the lowest unit occupancy quintiles (Q1 and Q2), infants were 12% and 11% less likely to be discharged compared to the expected number. At the highest unit occupancy quintile (Q5), infants were 20% more likely to be discharged. Highest occupancy (Q5) was also associated with a 4.7-day (95% CI 1.7, 7.7) reduction in LOS compared Q1., Conclusion: NICU occupancy was associated with likelihood of discharge and LOS among infants born <33 weeks GA., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Published
2023
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43. Use of SMOF lipid emulsion in very preterm infants does not affect the incidence of bronchopulmonary dysplasia-free survival.

Author

Ndiaye ABKT, Mohamed I, Pronovost E, Angoa G, Piedboeuf B, Lemyre B, Afifi J, Qureshi M, Sériès T, Guillot M, Simonyan D, Yusuf K, Lavoie PM, Fraser WD, Mâsse B, Nuyt AM, Lacaze-Masmonteil T, and Marc I

Subjects
Infant, Infant, Newborn, Humans, Incidence, Cohort Studies, Infant, Premature, Canada, Fat Emulsions, Intravenous, Docosahexaenoic Acids therapeutic use, Bronchopulmonary Dysplasia epidemiology, Bronchopulmonary Dysplasia prevention & control, Infant, Premature, Diseases
Abstract

Background: We aim to assess whether the docosahexaenoic acid (DHA)-containing lipid emulsion (LE) SMOFlipid 20% (Fresenius Kabi Canada Ltd) is associated with bronchopulmonary dysplasia (BPD)-free survival at 36 weeks' postmenstrual age in very preterm infants., Methods: This cohort study is nested in the MOBYDIck randomized clinical trial (NCT02371460), which investigated the effect of maternal DHA supplementation on BPD-free survival in breastfed very preterm infants born between 23 0/7 and 28 6/7 weeks' gestation in 16 Canadian neonatal intensive care units (2015-2018). Parenteral SMOF-LE was given to the infants according to the sites' routine care protocols. Relative risks (RRs) were estimated using a modified Poisson regression model with generalized estimating equations taking into account recruitment site, multiple birth, DHA supplementation, birth weight, sex, and gestational age., Results: Among 528 infants (mean gestational age, 26.5 weeks [SD, 1.6]), 272 received SMOF-LE. Overall, 56.7% of the infants in the SMOF-LE group and 59.7% infants in the non-SMOF-LE group survived without BPD (adjusted RR, 0.94 [95% CI, 0.77-1.14]; P = 0.51). BPD rates were 39.3% in the SMOF-LE group vs 34.1% in the non-SMOF-LE group (adjusted RR, 1.10 [95% CI, 0.82-1.47]; P = 0.53). Severe BPD rates were 31.8% in the SMOF-LE group vs 28.8% in the non-SMOF-LE group (adjusted P = 0.59). Mortality was not significantly different between the SMOF-LE (6.7%) and non-SMOF-LE groups (9.5%; adjusted P = 0.40)., Conclusion: In very preterm infants, intravenous DHA-containing SMOF-LE during the neonatal period was not associated with BPD-free survival., (© 2022 American Society for Parenteral and Enteral Nutrition.)

Published
2022
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44. Epidemiology of post-hemorrhagic ventricular dilatation in very preterm infants.

Author

Afifi J, Shah PS, Ye XY, Shah V, Piedboeuf B, Barrington K, Kelly E, and El-Naggar W

Subjects
Canada epidemiology, Cerebral Hemorrhage complications, Cerebral Hemorrhage epidemiology, Cerebral Ventricles, Dilatation, Female, Fetal Growth Retardation, Humans, Infant, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases epidemiology
Abstract

Objective: To describe the incidence, trends, management's variability and short-term outcomes of preterm infants with severe post-hemorrhagic ventricular dilatation (sPHVD)., Methods: We reviewed infants &lt;33 weeks' gestation who had PHVD and were admitted to the Canadian Neonatal Network between 2010 and 2018. We compared perinatal characteristics and short-term outcomes between those with sPHVD and those with mild/moderate PHVD and those with and without ventriculo-peritoneal (VP) shunt., Results: Of 29,417 infants, 2439 (8%) had PHVD; rate increased from 7.3% in 2010 to 9.6% in 2018 (P = 0.005). Among infants with PHVD, sPHVD (19%) and VP shunt (29%) rates varied significantly across Canadian centers and between geographic regions (P &lt; 0.01 and P = 0.0002). On multivariable analysis, sPHVD was associated with greater mortality, seizures and meningitis compared to mild/moderate PHVD., Conclusions: Significant variability in sPHVD and VP shunt rates exists between centers and regions in Canada. sPHVD was associated with increased mortality and morbidities., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Published
2022
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45. Halting the Canadian STRIDER randomised controlled trial of sildenafil for severe, early-onset fetal growth restriction: ethical, methodological, and pragmatic considerations.

Author

von Dadelszen P, Audibert F, Bujold E, Bone JN, Sandhu A, Li J, Kariya C, Chung Y, Lee T, Au K, Skoll MA, Vidler M, Magee LA, Piedboeuf B, Baker PN, Lalji S, and Lim KI

Subjects
Canada, Female, Gestational Age, Humans, Placenta Growth Factor therapeutic use, Pregnancy, Randomized Controlled Trials as Topic, Sildenafil Citrate therapeutic use, Ultrasonography, Prenatal adverse effects, Fetal Growth Retardation chemically induced, Fetal Growth Retardation drug therapy, Umbilical Arteries diagnostic imaging
Abstract

Objectives: To determine the efficacy and safety of sildenafil citrate to improve outcomes in pregnancies complicated by early-onset, dismal prognosis, fetal growth restriction (FGR). Eligibility: women ≥ 18 years, singleton, 18 + 0-27 + 6 weeks' gestation, estimated fetal weight < 700 g, low PLFG, and ≥ 1 of (i) abdominal circumference < 10th percentile for gestational age (GA); or (ii) reduced growth velocity and either abnormal uterine artery Doppler or prior early-onset FGR with adverse outcome. Ineligibility criteria included: planned termination or reversed umbilical artery end-diastolic flow. Eligibility confirmed by placental growth factor (PLGF) < 5 th percentile for GA measured post randomization. Women randomly received (1:1) either sildenafil 25 mg three times daily or matched placebo until either delivery or 31 + 6 weeks., Primary Outcome: delivery GA. The trial stopped early when Dutch STRIDER signalled potential harm; despite distinct eligibility criteria and IRB and DSMB support to continue, because of futility. NCT02442492 [registered 13/05/2015]., Results: Between May 2017 and June 2018, 21 (90 planned) women were randomised [10 sildenafil; 11 placebo (1 withdrawal)]. Baseline characteristics, PLGF levels, maternal and perinatal outcomes, and adverse events did not differ. Delivery GA: 26 + 6 weeks (sildenafil) vs 29 + 2 weeks (placebo); p = 0.200. Data will contribute to an individual participant data meta-analysis., (© 2022. The Author(s).)

Published
2022
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46. Maternal High-Dose DHA Supplementation and Neurodevelopment at 18-22 Months of Preterm Children.

Author

Guillot M, Synnes A, Pronovost E, Qureshi M, Daboval T, Caouette G, Olivier F, Bartholomew J, Mohamed I, Massé E, Afifi J, Hendson L, Lemyre B, Luu TM, Strueby L, Cieslak Z, Yusuf K, Pelligra G, Ducruet T, Ndiaye ABKT, Angoa G, Sériès T, Piedboeuf B, Nuyt AM, Fraser W, Mâsse B, Lacaze-Masmonteil T, Lavoie PM, and Marc I

Subjects
Child Development, Dietary Supplements, Double-Blind Method, Female, Gestational Age, Humans, Infant, Infant, Newborn, Docosahexaenoic Acids, Lactation
Abstract

Objectives: To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months' corrected age (CA)., Methods: Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks' gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks' postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months' CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks' gestation) and sex., Results: Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months' CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were -0.07 (95% confidence interval [CI] -3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI -1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI -2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks' gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08-10.03, P = .05). There was no interaction between treatment group and sex., Conclusions: Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months' CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks' GA., (Copyright © 2022 by the American Academy of Pediatrics.)

Published
2022
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47. Comparison of Three Nursing Workload Assessment Tools in the Neonatal Intensive Care Unit and Their Association with Outcomes of Very Preterm Infants.

Author

Lemieux-Bourque C, Piedboeuf B, Gignac S, Taylor-Ducharme S, Julien AS, and Beltempo M

Subjects
Canada, Humans, Infant, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Retrospective Studies, Workload, Infant, Premature, Diseases, Neonatal Nursing
Abstract

Objective: Nursing workload assessment tools are widely used to determine nurse staffing requirements in the neonatal intensive care unit (NICU). We aimed to compare three existing workload assessment tools and assess their association with mortality or morbidity among very preterm infants., Study Design: Single-center retrospective cohort study of infants born <33 weeks and admitted to a 52-bed tertiary NICU in 2017 to 2018. Required nurse staffing was estimated for each shift using the Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) used as reference tool, the Quebec Provincial NICU Nursing Ratio (QPNNR), and the Canadian NICU Resource Utilization (CNRU). Poisson regression models with robust error variance estimators were used to assess the association between nursing provision ratios (actual number of nurses/required number of nurses) during the first 7 days of admission and neonatal outcomes., Results: Median number of nurses required per shift using the WANNNT was 25.0 (interquartile range [IQR]: 23.1-26.7). Correlation between WANNNT and QPNNR was high ( r  = 0.92, p  < 0.0001), but the QPNNR underestimated the number of nurses per shift by 4.8 (IQR: 4.1-5.4). Correlation between WANNNT and CNRU was moderate ( r  = 0.45, p  < 0.0001). The NICU nursing provision ratios during the first 7 days of admission calculated using the WANNNT (adjusted risk ratio [aRR]: 0.96, 95% confidence interval [CI]: 0.93-0.99) and QPNNR (aRR: 0.97, 95% CI: 0.95-0.99) were associated with mortality or morbidity., Conclusion: Lower nursing provision ratio calculated using the WANNNT and CNRU during the first 7 days of admission is associated with an increased risk of mortality/morbidity in very preterm infants., Key Points: · NICUs use different nursing workload assessment tools.. · We validated three different nursing workload assessment tools used in the NICU.. · Nursing provision ratio is associated the risk of mortality/morbidity in preterm infants.., Competing Interests: None declared., (Thieme. All rights reserved.)

Published
2022
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48. Asphyxiated Neonates Treated with Hypothermia: Birth Place Matters.

Author

Sabsabi B, Huet C, Rampakakis E, Beltempo M, Brown R, Lodygensky GA, Piedboeuf B, and Wintermark P

Subjects
Cesarean Section statistics & numerical data, Child Health Services, Female, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Intensive Care Units, Neonatal, Male, Patient Transfer, Retrospective Studies, Treatment Outcome, Asphyxia Neonatorum therapy, Hypothermia, Induced
Abstract

Objective: This study aimed to assess whether the hospital level of care where asphyxiated neonates treated with hypothermia were originally born influences their outcome., Study Design: We conducted a retrospective cohort study of all asphyxiated neonates treated with hypothermia in a large metropolitan area. Birth hospitals were categorized based on provincially predefined levels of care. Primary outcome was defined as death and/or brain injury on brain magnetic resonance imaging (adverse outcome) and was compared according to the hospital level of care., Results: The overall incidence of asphyxiated neonates treated with hypothermia significantly decreased as hospital level of care increased: 1 per 1,000 live births (109/114,627) in level I units; 0.9 per 1,000 live births (73/84,890) in level II units; and 0.7 per 1,000 live births (51/71,093) in level III units ( p  < 0.001). The rate of emergent cesarean sections and the initial pH within the first hour of life were significantly lower in level I and level II units compared with level III units (respectively, p  < 0.001 and p  = 0.002). In a multivariable analysis adjusting for the rates of emergent cesarean sections and initial pH within the first hour of life, being born in level I units was confirmed as an independent predictor of adverse outcome (adjusted odds ratio [OR] level I vs. level III 95% confidence interval [CI]: 2.13 [1.02-4.43], p  = 0.04) and brain injury (adjusted OR level I vs. level III 95% CI: 2.41 [1.12-5.22], p  = 0.02)., Conclusion: Asphyxiated neonates born in level I units and transferred for hypothermia treatment were less often born by emergent cesarean sections, had worse pH values within the first hour of life, and had a higher incidence of adverse outcome and brain injury compared with neonates born in level III units. Further work is needed to optimize the initial management of these neonates to improve outcomes, regardless of the location of their hospital of birth., Key Points: · The incidence of asphyxiated neonates treated with hypothermia varied by hospital level of care.. · Their rates of emergent cesarean sections and their initial pH within the first hour of life varied by hospital level of care.. · The hospital level of care was an independent predictor of their adverse outcome, defined as death and/or brain injury on brain MRI.., Competing Interests: None declared., (Thieme. All rights reserved.)

Published
2022
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49. Effect of Maternal Docosahexaenoic Acid Supplementation on Very Preterm Infant Growth: Secondary Outcome of a Randomized Clinical Trial.

Author

Angoa G, Pronovost E, Ndiaye ABKT, Lavoie PM, Lemyre B, Mohamed I, Simonyan D, Qureshi M, Afifi J, Yusuf K, Sériès T, Guillot M, Piedboeuf B, Fraser WD, Nuyt AM, Mâsse B, Lacaze-Masmonteil T, and Marc I

Subjects
Canada, Dietary Supplements, Female, Fetal Growth Retardation drug therapy, Humans, Infant, Infant, Newborn, Infant, Premature, Lactation, Male, Docosahexaenoic Acids, Infant, Premature, Diseases drug therapy
Abstract

Introduction: The aim of the study was to determine the effect of a maternal docosahexaenoic acid (DHA) supplementation during lactation, compared with a placebo, on the neonatal growth profile of breastfed very preterm infants., Methods: Preterm infants' growth profile, growth velocity from birth to 36 weeks' postmenstrual age (PMA), and growth at 36 weeks' PMA were pre-specified secondary outcomes of a randomized placebo-controlled trial conducted in 16 Canadian neonatal intensive care units (2015-2018). Lactating mothers who delivered before 29 weeks' gestation were given 1.2 g of DHA daily or a placebo within 72 h of delivery and up to 36 weeks' PMA. Analyses were performed using a linear regression model with generalized estimating equations., Results: 461 mothers and their 528 infants (DHA, N = 273; placebo, N = 255) were included with mean gestational age of 26.5 weeks (standard deviation [SD] = 1.6); 275 (52.1%) were males; mean birth weight was 895 g (SD = 240). DHA interaction with sex was significant on weight profile (interaction p < 0.001), weight velocity (interaction p = 0.05), and weight at 36 weeks' PMA (interaction p = 0.02). Females in the DHA group gained more weight compared to the placebo group (mean difference [MD], 52.6 g [95% confidence interval [CI]: 24.5-80.8], p < 0.001). Weight velocity was significantly higher in females of the DHA group (MD, 3.4 g/kg/day [95% CI: 0.6-6.2], p = 0.02). At 36 weeks' PMA, the weight of males in the DHA group was significantly smaller (MD, -88.9 g [95% CI: -166.2 to -11.6], p = 0.02)., Conclusion: DHA positively affected female infants' neonatal weight profile and velocity and negatively affected male infants' weight at 36 weeks' PMA., (© 2022 S. Karger AG, Basel.)

Published
2022
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50. Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial.

Author

Fougère H, Bilodeau JF, Lavoie PM, Mohamed I, Rudkowska I, Pronovost E, Simonyan D, Berthiaume L, Guillot M, Piedboeuf B, Julien P, and Marc I

Subjects
Adult, Chlorophyta chemistry, Female, Humans, Infant, Newborn, Infant, Premature, Milk, Human drug effects, Mothers, Dietary Supplements, Docosahexaenoic Acids administration & dosage, Fatty Acids analysis, Milk, Human metabolism, Plant Oils administration & dosage
Abstract

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes., (© 2021. The Author(s).)

Published
2021
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