Developmental Pediatrician Department of Pediatrics and Child Health, University of Manitoba University of Manitoba Winnipeg, Manitoba, Canada
Background: Quality improvement programs across Canadian Neonatal Network (CNN) sites have led to increased neonatal survival without major neonatal morbidity among infants born extremely preterm. The next step is to determine if such activities impact longer-term survival and neurodevelopmental outcomes.
Design/Methods: This cohort study aimed to compare death or significant neurodevelopmental impairment (sNDI) (Bayley-III scores < 70, severe cerebral palsy, blind or hearing aided) at 18-24 months corrected age among infants born <29 weeks’ gestation admitted to CNN sites, between 2 Epochs: 1 (2009-2012) and 2 (2013-2016). Secondary objectives included death or neurodevelopmental impairment (NDI) (Bayley-III < 85, any cerebral palsy, visual or hearing impairment), death, sNDI, NDI and components of neurodevelopmental impairment. Only sites with ≥ 70% follow-up rates were included. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Pearson Chi-square and Student t-test test. Adjusted odds ratios with 95% CIs were calculated for outcome change between the 2 Epochs accounting for patient characteristic differences in the model.
Results: Study population included 4426 children; Epoch 1: 1895 (43%) and Epoch 2: 2531(57%). In Epoch 2 more mothers received MgSO4 (56.3% vs. 28.4%; p<0.01), antibiotics (69%vs.65.3%; p 0.01) and delayed cord clamping (37.1% vs. 31.3%; p 0.02), and fewer infants had SNAP-2 >20 (30.7% vs. 35.2%; p<0.01) or late onset sepsis (23.3% vs. 26.9%; p 0.01). See attached table for results. Conclusion(s): Significant reductions in rate of death or sNDI, and in visual and hearing impairment, were identified between Epoch 2 to Epoch 1. An increase in poor cognitive outcome rates requires further study.
Table 1 (Result Section)
Authors/Institutions: M. Florencia Ricci, University of Manitoba, Winnipeg, Manitoba, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, Ontario, Canada; Diane Moddemann, University of Manitoba, Winnipeg, Manitoba, Canada; Ruben Alvaro, University of manitoba, Winnipeg, Manitoba, Canada; Eugene Ng, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Shoo Lee, Mount Sinai Hospital, Toronto, Ontario, Canada; Anne Synnes, BC Women's Hospital, Vancouver, British Columbia, Canada