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Outcomes and care practices for preterm infants born at less than 33 weeks' gestation: a quality-improvement study
Shoo K Lee1, Marc Beltempo1, Douglas D McMillan1
1Department of Pediatrics and Maternal-Infant Care Research Centre (Lee), Sinai Health System; Departments of Pediatrics, and Obstetrics and Gynecology, and Dalla Lana School of Public Health (Lee), University of Toronto, Toronto, Ont.; Department of Pediatrics (Beltempo), Montreal Children's Hospital and McGill University Health Centre, Montréal, Que.; Department of Pediatrics (McMillan), IWK Health Centre and Dalhousie University, Halifax, NS; Department of Pediatrics and Child Health (Seshia), Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Man.; Department of Pediatrics, Foothills Medical Centre and University of Calgary (Singhal), Calgary, Alta.; Department of Paediatrics/Neonatology (Dow), Kingston Health Sciences Centre and Queen's University, Kingston, Ont.; Department of Pediatrics (Aziz), Royal Alexandra Hospital and University of Alberta, Edmonton, Alta.; Department of Pediatrics (Piedboeuf), Centre hospitalier universitaire de Québec and Université Laval, Québec, Que.; Department of Pediatrics, Sinai Health System (Shah); Department of Pediatrics, and Institute of Health Policy, Management and Evaluation (Shah), University of Toronto, Toronto, Ont.
Insights
Quality improvement initiatives significantly boosted survival rates for very preterm infants in Canada. These programs enhanced neonatal care practices, leading to better outcomes for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Public Health
Background:
- Preterm birth is a major cause of infant mortality and morbidity.
- This study examines changes in neonatal outcomes and care for very preterm infants over 14 years.
- It focuses on a national quality improvement program in Canada.
Purpose of the Study:
- To report changes in neonatal outcomes and care practices among very preterm infants.
- To evaluate the impact of a national quality improvement program.
- To identify trends over a 14-year period (2004-2017).
Main Methods:
- Retrospective study of infants born at 23-32 weeks' gestation.
- Inclusion of tertiary neonatal intensive care units in the Canadian Neonatal Network.
- Analysis using process-control charts, adjusted regression models, and interrupted time series analyses.
Main Results:
- Survival without major morbidity increased significantly from 56.6% to 70.9% annually.
- Survival rates for infants born at 23-25 weeks' gestation also improved.
- Key practice changes included increased antenatal steroid use, higher rates of normothermia, and reduced pulmonary surfactant use.
Conclusions:
- Network-wide quality improvement activities can lead to sustained improvements in survival without morbidity for very preterm infants.
- Effective implementation of optimal care practices is crucial.
- Collaborative efforts enhance neonatal care outcomes.
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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