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Journal of Pediatrics, The

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Severe Neurodevelopmental Impairment in Neonates Born Preterm: Impact of Varying Definitions in a Canadian Cohort - 23/05/18

Doi : 10.1016/j.jpeds.2017.12.020 
Matthew D. Haslam, MSc 1, Sarka Lisonkova, MD, PhD 1, 2, Dianne Creighton, PhD 3, Paige Church, MD 4, Junmin Yang, MSc 4, Prakesh S. Shah, MD, MBBS, MSc 4, K.S. Joseph, MD, PhD 1, 2, Anne Synnes, MDCM, MHSc 5, *
on behalf of the

Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network*

  List of additional members of the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network is available at www.jpeds.com (Appendix).
Adele Harrison, MD, MBChB 6, Joseph Ting, MD 7, Zenon Cieslak, MD 8, Rebecca Sherlock, MD 9, Wendy Yee, MD 10, Carlos Fajardo, MD 11, Khalid Aziz, MBBS, MA, MEd 12, Jennifer Toye, MD 12, Zarin Kalapesi, MD 13, Koravangattu Sankaran, MD, MBBS 14, Sibasis Daspal, MD 14, Molly Seshia, MBChB 15, Ruben Alvaro, MD 16, Amit Mukerji, MD 17, Orlando Da Silva, MD, MSc 18, Chuks Nwaesei, MD 19, Kyong-Soon Lee, MD, MSc 20, Michael Dunn, MD 21, Brigitte Lemyre, MD 22, Kimberly Dow, MD 23, Ermelinda Pelausa, MD 24, Lajos Kovacs, MD 24, Keith Barrington, MBChB 25, Christine Drolet, MD 26, Bruno Piedboeuf, MD 26, S. Patricia Riley, MD 27, Martine Claveau, RN 27, Daniel Faucher, MD 28, Valerie Bertelle, MD 29, Edith Masse, MD 29, Roderick Canning, MD 30, Hala Makary, MD 31, Cecil Ojah, MBBS 32, Luis Monterrosa, MD 32, Wayne Andrews, MD 33, Akhil Deshpandey, MD, MBBS 33, Doug McMillan, MD 34, Jehier Afifi, MB, BCh, MSc 34, Andrzej Kajetanowicz, MD 35, Shoo K. Lee, MBBS, PhD 36, Thevanisha Pillay, MD 6, Reg Sauvé, MD, MPh 37, Leonora Hendson, MB.BCH, MSc 37, Amber Reichert, MD 38, Jaya Bodani, MD 13, Koravangattu Sankaran, MD 14, Diane Moddemann, MD 39, Chukwuma Nwaesei, MD 19, Thierry Daboval, MD 22, Kimberly Dow 23, David Lee, MD 40, Linh Ly, MD 20, Edmond Kelly, MD 36, Salhab el Helou, MD 17, Ermelinda Pelausa, MD 24, S. Patricia Riley, MD 41, Francine Lefebvre 42, Charlotte Demers 29, Sylvie Bélanger, MD 43, Roderick Canning, MD 30, Luis Monterrosa, MD 32, Hala Makary, MD 31, Michael Vincer, MD 34, Phil Murphy 44
6 Victoria General Hospital, Victoria, British Columbia 
7 British Columbia Women's Hospital, Vancouver, British Columbia 
8 Royal Columbian Hospital, New Westminster, British Columbia 
9 Surrey Memorial Hospital, Surrey, British Columbia 
10 Foothills Medical Centre, Calgary, Alberta 
11 Alberta Children's Hospital, Calgary, Alberta 
12 Royal Alexandra Hospital and University of Alberta Hospital, Edmonton, Alberta 
13 Regina General Hospital, Regina, Saskatchewan 
14 Royal University Hospital, Saskatoon, Saskatchewan 
15 Winnipeg Health Sciences Centre, Winnipeg, Manitoba 
16 St. Boniface General Hospital, Winnipeg, Manitoba 
17 Hamilton Health Sciences Centre, Hamilton, Ontario 
18 London Health Sciences Centre, London, Ontario 
19 Windsor Regional Hospital, Windsor, Ontario 
20 Hospital for Sick Children, Toronto, Ontario 
21 Sunnybrook Health Sciences Centre, Toronto, Ontario 
22 Children's Hospital of Eastern Ontario, Ottawa, Ontario 
23 Kingston General Hospital, Kingston, Ontario 
24 Jewish General Hospital, Montréal, Québec 
25 Hôpital Sainte-Justine, Montréal, Québec 
26 Centre Hospitalier Universitaire de Québec, Sainte Foy, Québec 
27 Montreal Children's Hospital, Montréal, Québec 
28 Royal Victoria Hospital, Montréal, Québec 
29 Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec 
30 Moncton Hospital, Moncton, New Brunswick 
31 Dr. Everett Chalmers Hospital, Fredericton, New Brunswick 
32 Saint John Regional Hospital, Saint John, New Brunswick 
33 Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland 
34 IWK Health Centre, Halifax, Nova Scotia 
35 Cape Breton Regional Hospital, Sydney, Nova Scotia 
36 Mount Sinai Hospital, Toronto, Ontario 
37 Alberta's Children's Hospital, Foothills Medical Centre, Calgary, Alberta 
38 Glenrose Rehabilitation Hospital, Edmonton, Alberta 
39 Winnipeg Health Sciences Centre, St. Boniface General Hospital, Winnipeg, Manitoba 
40 Children's Hospital London Health Sciences Centre, London, Ontario 
41 Montréal Children's Hospital, Royal Victoria Hospital, Montréal, Québec 
42 Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec 
43 Centre Hospitalier Universitaire de Québec, Québec City, Québec 
44 Charles Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland 

1 School of Population and Public Health, University of British Columbia, British Columbia, Canada 
2 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada 
3 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada 
4 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 
5 Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada 

*Reprint requests: Anne Synnes, MDCM, MHSc, Room 1R13, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, BC, V6H 3V4, Canada.Room 1R13BC Women's Hospital and Health Centre4500 Oak StVancouverBCV6H 3V4Canada

Abstract

Objective

To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort.

Study design

Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included. The incidence of severe NDI, aORs, and 95% CIs were calculated to express the relationship between risk factors and severe NDI using the definitions with the highest and the lowest incidence rates of severe NDI.

Results

The incidence of severe NDI ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI 3.37-5.47). The associations between risk factors and severe NDI varied depending on the definition used. Maternal ethnicity, employment status, antenatal corticosteroid treatment, and gestational age were not associated consistently with severe NDI. Although maternal substance use, sex, score of neonatal acute physiology >20, late-onset sepsis, bronchopulmonary dysplasia, and brain injury were consistently associated with severe NDI irrespective of definition, the strength of the associations varied.

Conclusions

The definition of severe NDI significantly influences the incidence and the associations between risk factors and severe NDI. A standardized definition would facilitate site comparisons and scientific communication.

Le texte complet de cet article est disponible en PDF.

Keywords : neonatology, developmental follow-up, epidemiology, statistics

Abbreviations : Bayley-III, BSID-II, CNFUN, CNN, GMFCS, NDI, NICU, SNAP-II


Plan


 M.H. and S.L. were supported by the Canadian Institutes of Health Research (CIHR; MAH-115445 and CTP 875518). P.S. and K.J. are supported by Applied Research Chairs in Reproductive and Child Health Services Research from CIHR. The data collection was supported by the CIHR through a grant to the CIHR Team in Maternal-Infant Care (CTP 87518). The study coordinating center, the Maternal-Infant Care Research Centre, is supported by program funding from the Ontario Ministry of Health and Long-Term Care. In addition, participating sites contributed additional funding for patient outcome assessments. The authors declare no conflicts of interest.
 Portions of this study were presented as an abstract at the Canadian National Perinatal Research Meeting, February 10-13, 2016, Banff, Alberta, Canada; the Pediatric Academic Societies Annual Meeting, April 30-May 3, 2016, Baltimore, Maryland; and the Society for Pediatric and Perinatal Epidemiologic Research 29th Annual Meeting, June 20-21, 2016, Miami, Florida.


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Vol 197

P. 75 - juin 2018 Retour au numéro
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  • Timothy P. Stevens, Eileen Shields, Deborah Campbell, Adriann Combs, Michael Horgan, Edmund F. La Gamma, KuangNan Xiong, Marilyn Kacica

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