Paediatrics Publications

Title

Outcomes and care practices for preterm infants born at less than 33 weeks’ gestation: A quality-improvement study

Authors

Shoo K. Lee, Sinai Health System
Marc Beltempo, Centre Universitaire de Santé McGill, Hôpital de Montreal Pour Enfants
Douglas D. McMillan, Dalhousie University, Faculty of Medicine
Mary Seshia, University of Manitoba
Nalini Singhal, University of Calgary
Kimberly Dow, Queen’s University
Khalid Aziz, University of Alberta, Faculty of Medicine and Dentistry
Bruno Piedboeuf, CHU de Québec - Université Laval
Prakesh S. Shah, Institute of Health Policy, Management and Evaluation
Vibhuti Shah, Institute of Health Policy, Management and Evaluation
Anne Synnes, Children's and Women's Health Centre of British Columbia
Wendy Yee, University of Calgary
Xiang Y. Ye, Mount Sinai Hospital of University of Toronto
Julie Emberley, New Janeway Children’s Health and Rehabilitation Centre
Akhil Deshpandey, New Janeway Children’s Health and Rehabilitation Centre
Jehier Afifi, IWK Health Centre
Hala Makary, Dr. Everett Chalmers Regional Hospital
Roderick Canning, The Moncton Hospital
Luis Monterrosa, Saint John Regional Hospital
Christine Drolet, CHU de Québec - Université Laval
Keith Barrington, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Anie Lapointe, CHU Sainte-Justine - Le Centre Hospitalier Universitaire Mère-Enfant
Ermelinda Pelausa, Sir Mortimer B. Davis Jewish General Hospital
Patricia Riley, Centre Universitaire de Santé McGill, Hôpital de Montreal Pour Enfants
Therese Perreault, Centre Universitaire de Santé McGill, Hôpital de Montreal Pour Enfants
Jennifer Twiss, Hamilton Health Sciences
Amit Mukerji, Hamilton Health Sciences
Sandesh Shivananda, Hamilton Health Sciences
Faiza Khurshid, Queen’s University

Document Type

Article

Publication Date

1-27-2020

Journal

CMAJ

Volume

192

Issue

4

First Page

E81

Last Page

E91

URL with Digital Object Identifier

10.1503/cmaj.190940

Abstract

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23–32 weeks’ gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06–1.10, per year) across all gestational ages. Survival of infants born at 23–25 weeks’ gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02–1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.

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