Variations in practice and outcomes in the Canadian NICU network: 1996-1997

Area of Science:

• Neonatalogy
• Pediatric Intensive Care
• Health Services Research

Background:

• Previous studies on neonatal intensive care unit (NICU) outcome variations focused on specific infant subpopulations like very low birth weight (VLBW) infants.
• A comprehensive understanding of practice and outcome variations across a broader NICU population was lacking.

Purpose of the Study:

• To report on current practice and outcome variations in a population-based national study of Canadian NICUs.
• To establish a national database for future research, resource allocation, and policy design in neonatal care.

Main Methods:

• Prospective data collection from 20,488 admissions to 17 tertiary level NICUs in Canada (January 1996 - October 1997).
• Standardized data collection by trained abstractors, including demographics, antenatal history, delivery details, infant status, illness severity (e.g., CRIB, PSS, PSS-II), therapeutic intensity (NTISS), NICU practices, and patient outcomes.
• Data verification and analysis by a steering committee of experienced researchers and neonatologists; patient tracking until discharge or death.

Main Results:

• The study included 20,488 NICU admissions, with 53% <2500g birth weight (BW), 20% VLBW (<1500g BW), and 65% preterm (<38 weeks gestational age [GA]).
• Significant variations were observed in antenatal steroid use (23%-76%), respiratory support (43%), surfactant use (14%), and nitric oxide administration.
• Overall survival was 96%, but varied by GA. For VLBW infants: 87% survival, 26% chronic lung disease, 11% severe retinopathy of prematurity (ROP), 10% severe intraventricular hemorrhage (IVH), 22% nosocomial infection, 7% necrotizing enterocolitis (NEC). 69% survived without major morbidity.

Conclusions:

• This population-based study highlights significant variations in NICU practices and outcomes across Canada, even within a universal health insurance system.
• The established national database is crucial for informing research, resource allocation, health policy, and guiding longitudinal studies on NICU care.
• Observed variations underscore the need for standardized care protocols and targeted interventions to improve neonatal outcomes nationwide.