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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Cumulative effect of evidence-based practices on outcomes of preterm infants born at <29 weeks' gestational age
Angelo Rizzolo1, Prakesh S Shah2, Isabelle Boucorian3
1Department of Pediatrics, Montreal Children's Hospital-McGill University Health Centre, Montreal, QC, Canada.
Insights
For extremely preterm infants, using at least two evidence-based practices, such as antenatal corticosteroids and delayed cord clamping, significantly reduces the risk of death and severe neurological injury.
Area of Science:
- Neonatal Intensive Care
- Perinatal Medicine
- Neuroprotection Strategies
Background:
- Extremely preterm infants (<29 weeks' gestational age) face high risks of mortality and severe neurological injury.
- Individual evidence-based practices have shown promise in neuroprotection for this vulnerable population.
Purpose of the Study:
- To evaluate the cumulative impact of four key evidence-based practices on the outcomes of extremely preterm infants.
- To determine the association between exposure to these practices and the rates of death and/or severe neurological injury.
Main Methods:
- An observational study analyzed data from extremely preterm infants (23-28 weeks' gestational age) in the Canadian Neonatal Network (2015-2017).
- Four practices were assessed: antenatal corticosteroids, antenatal MgSO4, deferred cord clamping (≥30 seconds), and normothermia on admission.
- Multivariable logistic regression models adjusted for patient characteristics to assess the effect of cumulative exposure to these practices.
Main Results:
- The overall rate of death and/or severe neurological injury was 20%.
- Infants exposed to two or more practices had significantly lower odds of death and/or severe neurological injury compared to those exposed to none (aOR, 0.61; 95% CI, 0.43-0.88).
- Antenatal corticosteroids (aOR, 0.52; 95% CI, 0.40-0.69) and deferred cord clamping (aOR, 0.81; 95% CI, 0.68-0.96) were significantly associated with reduced odds, while MgSO4 and normothermia were not.
Conclusions:
- Exposure to a cumulative approach of at least two evidence-based practices is associated with improved outcomes in extremely preterm infants.
- This finding supports the implementation of multiple neuroprotective strategies in the care of this high-risk group.
- Targeting antenatal corticosteroids and deferred cord clamping may be particularly beneficial for reducing adverse outcomes.
Background:
Extremely preterm infants born at <29 weeks' gestational age are at high risk of death or severe neurological injury. Several individual evidence-based practices have been associated with neuroprotection.
Objective:
The objective of the study was to investigate the cumulative effect of 4 evidence-based practices and their association with death and/or severe neurological injury among infants born at <29 weeks' gestational age.
Study Design:
Observational study of infants born at 230-286 weeks gestational age admitted to neonatal intensive care units participating in the Canadian Neonatal Network from 2015 through 2017. We evaluated 4 practices: antenatal corticosteroids, antenatal MgSO4 for neuroprotection, deferred cord clamping ≥30 seconds, and normothermia on admission. The effect of exposure to 1, 2, 3, and all 4 evidence-based practices compared with none on death and/or severe neurological injury was assessed using multivariable logistic regression models adjusted for patient characteristics.
Results:
Rate of death and/or severe neurological injury was 20% (873 of 4297) and varied based on exposure to evidence-based practices: none, 34% (54 of 157); 1, 27% (171 of 626); 2, 20% (295 of 1448); 3, 18% (263 of 1448); and all 4, 14% (90 of 618). Significantly lower odds of death and/or severe neurological injury were observed with exposure to antenatal corticosteroids (adjusted odds ratio, 0.52, 95% confidence interval, 0.40-0.69) and deferred cord clamping (adjusted odds ratio, 0.81, 95% confidence interval, 0.68-0.96) but not MgSO4 (adjusted odds ratio, 0.88, 95% confidence interval, 0.72-1.08) or normothermia (adjusted odds ratio, 0.96, 95% confidence interval, 0.79-1.16). Infants exposed to ≥2 evidence-based practices had significantly lower odds of death and/or severe neurological injury than those exposed to no evidence-based practices (adjusted odds ratio, 0.61, 95% confidence interval, 0.43-0.88).
Conclusion:
Among infants born at <29 weeks' gestational age, exposure to at least 2 of the evidence-based practices assessed was associated with decreased odds of death and/or severe neurological injury.
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