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Measuring severe neonatal morbidity using hospital discharge data in France
Elodie Lebreton1,2,3, Claudie Menguy2,3, Jeanne Fresson1,4
1INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Insights
The Neonatal Adverse Outcome Indicator (NAOI) effectively measures severe neonatal morbidity in France, showing similar prevalence to Australia and England. Further harmonization of coding is needed for international comparisons of infant health.
Area of Science:
- Neonatology
- Public Health Surveillance
- Epidemiology
Background:
- International consensus on neonatal morbidity indicators is lacking.
- The Neonatal Adverse Outcome Indicator (NAOI) is a composite indicator developed in Australia to assess severe neonatal morbidity using hospital discharge data.
Purpose of the Study:
- To evaluate the applicability of the NAOI in France for both public health surveillance and research purposes.
Main Methods:
- A cohort of live births (≥24 weeks gestational age) in Metropolitan France (2014-2015) was analyzed using hospital discharge, insurance claims, and death data.
- Outlier hospitals were identified using funnel plots of standardized morbidity ratios (SMR).
- The NAOI and its components were compared with Australian and English data, and risk factors for neonatal morbidity were analyzed.
Main Results:
- The study included 1,459,123 births across 511 hospitals.
- NAOI prevalence in France (4.8%) was comparable to Australia (4.6%) and England (5.4%).
- Risk factors identified included maternal age ≥40, state medical insurance, male sex, and birthweight <3rd percentile.
Conclusions:
- The NAOI is a valuable tool for assessing severe neonatal morbidity prevalence and risk factors in France.
- While prevalence is similar across high-income countries, harmonizing coding procedures, particularly for infection and respiratory conditions, is crucial for valid international comparisons.
Background:
Measuring infant health at birth is key for surveillance and research in obstetrics and neonatology, but there is no international consensus on morbidity indicators. The Neonatal Adverse Outcome Indicator (NAOI) is a composite indicator, developed in Australia, which measures the burden of severe neonatal morbidity using hospital discharge data.
Objective:
To evaluate the applicability of the NAOI in France for surveillance and research.
Methods:
We constituted a cohort of live births ≥24 weeks' gestational age in Metropolitan France from 2014 to 2015 using hospital discharge, insurance claims and cause of death data. Outlier hospitals were identified using funnel plots of standardised morbidity ratios (SMR), and their coding patterns were assessed. We compared the NAOI and its component codes with published Australian and English data and estimated unadjusted and adjusted risk ratios for known risk factors for neonatal morbidity.
Results:
We included 1,459,123 births (511 hospitals). Twenty-eight hospitals had SMR above funnel plot control limits. Newborns with NAOI morbidities in these hospitals had lower mortality and shorter stays than in other hospitals. Amongst within-limit hospitals, NAOI prevalence was 4.8%, comparable to Australia (4.6%) and England (5.4%). Most individual components had a similar prevalence, with the exception of respiratory support, intravenous fluid procedures and infection. NAOI was lowest at 39 weeks (2.2%) with higher risks for maternal age ≥40 (relative risk [RR] 1.47, 95% confidence interval [CI] 1.42, 1.51), state medical insurance (RR 1.60, 95% CI 1.52, 1.68), male sex (RR 1.21, 95% CI 1.19, 1.23) and birthweight <3rd percentile (RR 4.60, 95% CI 4.51, 4.69).
Conclusions:
The NAOI provides valuable information on population prevalence of severe neonatal morbidity and its risk factors. Whilst the prevalence was similar in high-income countries with comparable neonatal mortality levels, ensuring valid comparisons between countries and hospitals will require further work to harmonize coding procedures, especially for infection and respiratory morbidity.
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