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The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China
Di Jin1, Xinyue Gu2, Siyuan Jiang3
1Department of Neonatology, The First Hospital of Jilin University, Changchun, China, jindi@jlu.edu.cn.
Insights
Implementing multiple evidence-based practices significantly reduces early death and severe brain injury in very preterm infants. Comprehensive care, including antenatal corticosteroids and normothermic temperature, improves survival outcomes for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Perinatal Health
- Evidence-Based Practice
Background:
- Very preterm infants (<32 weeks gestational age) face high risks of mortality and severe neurodevelopmental impairment.
- Evidence-based healthcare practices are crucial for mitigating these adverse outcomes.
Purpose of the Study:
- To investigate the association between four key evidence-based practices and the incidence of early death and/or severe brain injury in very preterm infants.
- To determine if a greater number of implemented practices correlates with improved infant survival and reduced injury.
Main Methods:
- A cohort of 6,035 infants born at 24-316 weeks gestational age and admitted to NICUs within 24 hours was analyzed.
- The study examined the impact of inborn status, antenatal corticosteroids (ACS), magnesium sulfate (MgSO4), and normothermic temperature (NT) on infant outcomes.
Main Results:
- The overall incidence of early death and/or severe brain injury was 10.6%.
- Antenatal corticosteroids (ACS) alone showed a significant reduction in adverse outcomes (aOR, 0.71).
- A dose-response relationship was observed: utilizing more practices progressively decreased the incidence of death/injury, with 3 or 4 practices yielding the lowest rates (9%).
Conclusions:
- Comprehensive application of evidence-based practices is strongly associated with improved survival without severe brain injury in very preterm infants.
- Healthcare providers should aim for the widespread implementation of all four studied practices to optimize outcomes for this vulnerable population.
Introduction:
Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence.
Materials And Methods:
Infants born at 24-316 weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO4 (prenatal magnesium sulfate), and NT (normothermic temperature [36.0-37.5°C] at admission) and early death and/or severe brain injury in the study population.
Results:
Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57-0.88), but not MgSO4 only (aOR, 0.97; 95% CI: 0.81-1.17), NT only (aOR, 0.91; 95% CI: 0.76-1.08), or inborn only (aOR, 0.91; 95% CI: 0.72-1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482).
Discussion/Conclusion:
More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at <32 weeks gestational age.
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