Cumulative effect of evidence-based practices on outcomes of preterm infants born at <29 weeks’ gestational age - 28/01/20
on behalf of the
Canadian Neonatal Network and Canadian Preterm Birth Network Investigators
Abstract |
Background |
Extremely preterm infants born at <29 weeks’ gestational age are at high risk of death or severe neurological injury. Several individual evidence-based practices have been associated with neuroprotection.
Objective |
The objective of the study was to investigate the cumulative effect of 4 evidence-based practices and their association with death and/or severe neurological injury among infants born at <29 weeks’ gestational age.
Study Design |
Observational study of infants born at 230–286 weeks gestational age admitted to neonatal intensive care units participating in the Canadian Neonatal Network from 2015 through 2017. We evaluated 4 practices: antenatal corticosteroids, antenatal MgSO4 for neuroprotection, deferred cord clamping ≥30 seconds, and normothermia on admission. The effect of exposure to 1, 2, 3, and all 4 evidence-based practices compared with none on death and/or severe neurological injury was assessed using multivariable logistic regression models adjusted for patient characteristics.
Results |
Rate of death and/or severe neurological injury was 20% (873 of 4297) and varied based on exposure to evidence-based practices: none, 34% (54 of 157); 1, 27% (171 of 626); 2, 20% (295 of 1448); 3, 18% (263 of 1448); and all 4, 14% (90 of 618). Significantly lower odds of death and/or severe neurological injury were observed with exposure to antenatal corticosteroids (adjusted odds ratio, 0.52, 95% confidence interval, 0.40–0.69) and deferred cord clamping (adjusted odds ratio, 0.81, 95% confidence interval, 0.68-0.96) but not MgSO4 (adjusted odds ratio, 0.88, 95% confidence interval, 0.72–1.08) or normothermia (adjusted odds ratio, 0.96, 95% confidence interval, 0.79–1.16). Infants exposed to ≥2 evidence-based practices had significantly lower odds of death and/or severe neurological injury than those exposed to no evidence-based practices (adjusted odds ratio, 0.61, 95% confidence interval, 0.43–0.88).
Conclusion |
Among infants born at <29 weeks’ gestational age, exposure to at least 2 of the evidence-based practices assessed was associated with decreased odds of death and/or severe neurological injury.
Le texte complet de cet article est disponible en PDF.Key words : death, evidence-based practices, neuroprotection, preterm, severe neurological injury
Plan
| Although no specific funding has been received for this study, organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research team grant (CTP 87518), the Ontario Ministry of Health, and individual participating centers. Dr Shah holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the Canadian Institutes of Health Research (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| Dr Shah holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the Canadian Institutes of Health Research. The other authors report no conflict of interest. |
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| Cite this article as: Rizzolo A, Shah PS, Boucorian I, et al. Cumulative effect of evidence-based practices on outcomes of preterm infants born at <29 weeks’ gestational age. Am J Obstet Gynecol 2020;222:181.e1-10. |
Vol 222 - N° 2
P. 181.e1-181.e10 - février 2020 Retour au numéro
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