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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental Outcomes of Infants at <29 Weeks of Gestation Born in Canada Between 2009 and 2016
M Florencia Ricci1, Prakesh S Shah2, Diane Moddemann1
1Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
National quality improvement initiatives lowered death or significant neurodevelopmental impairment (NDI) in extremely preterm infants. Outcomes for very premature babies born 2013-2016 showed significant reductions in NDI, blindness, and hearing loss compared to 2009-2012.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Public Health Initiatives
Background:
- Infants born before 29 weeks gestation face high risks of mortality and neurodevelopmental impairment (NDI).
- National quality improvement initiatives aim to reduce adverse outcomes in this vulnerable population.
- Evaluating the impact of these initiatives is crucial for optimizing neonatal care.
Purpose of the Study:
- To assess changes in mortality and significant NDI in infants born at <29 weeks gestation.
- To determine the association between national quality improvement initiatives and infant outcomes.
- To compare outcomes between two distinct time periods reflecting initiative implementation.
Main Methods:
- Longitudinal cohort study of infants born between 22 and 28 weeks gestation in Canadian NICUs (2009-2016).
- Primary outcome: composite rate of death or significant NDI at 18-24 months corrected age.
- Outcomes compared between two epochs: 2009-2012 (epoch 1) and 2013-2016 (epoch 2), with adjusted odds ratios (aORs) calculated.
Main Results:
- A total of 4426 infants were included; 2531 in epoch 2 (2013-2016) and 1895 in epoch 1 (2009-2012).
- The composite rate of death or significant NDI was lower in epoch 2 (30%) versus epoch 1 (32%) (aOR, 0.86; 95% CI, 0.75-0.99).
- Significant reductions were observed in epoch 2 for blindness (0.6% vs. 1.4%; aOR, 0.38) and need for hearing aids (1.4% vs. 2.6%; aOR, 0.50).
Conclusions:
- Composite rates of death or significant NDI were significantly lower in preterm infants born at <29 weeks gestation in 2013-2016 compared to 2009-2012.
- Rates of visual and hearing impairment also showed significant reductions in the later epoch.
- These findings suggest the positive impact of national quality improvement initiatives on extremely preterm infants' outcomes.
Objective:
To evaluate changes in mortality or significant neurodevelopmental impairment (NDI) in children born at <29 weeks of gestation in association with national quality improvement initiatives.
Study Design:
This longitudinal cohort study included children born at 220/7 to 286/7 weeks of gestation who were admitted to Canadian neonatal intensive care units between 2009 and 2016. The primary outcome was a composite rate of death or significant NDI (Bayley Scales of Infant and Toddler Development, Third Edition score <70, severe cerebral palsy, blindness, or deafness requiring amplification) at 18-24 months corrected age. To evaluate temporal changes, outcomes were compared between epoch 1 (2009-2012) and epoch 2 (2013-2016). aORs were calculated for differences between the 2 epochs accounting for differences in patient characteristics.
Results:
The 4426 children included 1895 (43%) born in epoch 1 and 2531 (57%) born in epoch 2. Compared with epoch 1, in epoch 2 more mothers received magnesium sulfate (56% vs 28%), antibiotics (69% vs 65%), and delayed cord clamping (37% vs 31%) and fewer infants had a Score for Neonatal Acute Physiology, version II >20 (31% vs 35%) and late-onset sepsis (23% vs 27%). Death or significant NDI occurred in 30% of children in epoch 2 versus 32% of children in epoch 1 (aOR, 0.86; 95% CI, 0.75-0.99). In epoch 2, there were reductions in the need for hearing aids or cochlear implants (1.4% vs 2.6%; aOR, 0.50; 95% CI, 0.31-0.82) and in blindness (0.6% vs.1.4%; aOR, 0.38; 95% CI, 0.18-0.80).
Conclusions:
Among preterm infants born at <29 weeks of gestation, composite rates of death or significant NDI and rates of visual and hearing impairment were significantly lower in 2013-2016 compared with 2009-2012.
