Outcomes and care practices for preterm infants born at less than 33 weeks' gestation: a quality-improvement study

被引：68

作者：

Lee, Shoo K. ^{[1
,2
,3
,4
,5
,21
]}

Beltempo, Marc ^{[6
,7
]}

McMillan, Douglas D. ^{[8
,9
,28
]}

Seshia, Mary ^{[10
,11
,24
]}

Singhal, Nalini ^{[12
,13
,27
]}

Dow, Kimberly ^{[14
,15
,26
]}

Aziz, Khalid ^{[16
,17
,23
]}

Piedboeuf, Bruno ^{[18
,19
,25
]}

Shah, Prakesh S. ^{[3
,20
,21
]}

Ye, Xiang Y. ^{[21
]}

Emberley, Julie ^{[29
]}

Deshpandey, Akhil ^{[29
]}

Afifi, Jehier ^{[28
]}

McMillan, Douglas ^{[28
]}

Makary, Hala ^{[30
]}

Canning, Roderick ^{[31
]}

Monterrosa, Luis ^{[32
]}

Drolet, Christine ^{[25
]}

Barrington, Keith ^{[33
]}

Lapointe, Anie ^{[33
]}

Pelausa, Ermelinda ^{[34
]}

Riley, Patricia ^{[35
]}

Perreault, Therese ^{[35
]}

Twiss, Jennifer ^{[36
]}

Mukerji, Amit ^{[36
]}

Shivananda, Sandesh ^{[22
,36
]}

Khurshid, Faiza ^{[26
]}

Lee, David ^{[37
]}

da Silva, Orlando ^{[37
]}

Coughlin, Kevin ^{[37
]}

Rouvinez-Bouali, Nicole ^{[38
]}

Lemyre, Brigitte ^{[38
]}

Lee, Kyong Soon ^{[39
]}

Shah, Vibhuti ^{[21
]}

Ng, Eugene ^{[40
]}

Dunn, Michael ^{[40
]}

Nwaesei, Chukwuma ^{[41
]}

Alvaro, Ruben ^{[42
]}

Seshia, Molly ^{[24
]}

Kalapesi, Zarin ^{[43
]}

Bodani, Jaya ^{[43
]}

Daspal, Sibasis ^{[44
]}

Abou Mehrem, Ayman ^{[27
]}

Mohammad, Khorshid ^{[27
]}

Yee, Wendy ^{[27
]}

Synnes, Anne ^{[22
]}

Taylor, Richard ^{[45
]}

Harrison, Adele ^{[45
]}

机构：

[1] Sinai Hlth Syst, Dept Pediat, Toronto, ON, Canada

[2] Sinai Hlth Syst, Maternal Infant Care Res Ctr, Toronto, ON, Canada

[3] Univ Toronto, Dept Pediat, Toronto, ON, Canada

[4] Univ Toronto, Dept Obstet & Gynecol, Toronto, ON, Canada

[5] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[6] Montreal Childrens Hosp, Dept Pediat Beltempo, Montreal, PQ, Canada

[7] McGill Univ, Hlth Ctr, Montreal, PQ, Canada

[8] IWK Hlth Ctr, Dept Pediat, Halifax, NS, Canada

[9] Dalhousie Univ, Halifax, NS, Canada

[10] Winnipeg Childrens Hosp, Dept Pediat & Child Hlth, Winnipeg, MB, Canada

[11] Univ Manitoba, Winnipeg, MB, Canada

[12] Foothills Med Ctr, Dept Pediat, Calgary, AB, Canada

[13] Univ Calgary, Calgary, AB, Canada

[14] Kingston Hlth Sci Ctr, Dept Paediat Neonatol, Kingston, ON, Canada

[15] Queens Univ, Kingston, ON, Canada

[16] Royal Alexandra Hosp, Dept Pediat, Edmonton, AB, Canada

[17] Univ Alberta, Edmonton, AB, Canada

[18] CHU Quebec, Dept Pediat, Que, PQ, Canada

[19] Univ Laval, Laval, PQ, Canada

[20] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[21] Mt Sinai Hosp, Toronto, ON, Canada

[22] BC Womens Hosp & Hlth Ctr, Vancouver, BC, Canada

[23] Royal Alexandra Hosp, Edmonton, AB, Canada

[24] Univ Manitoba, Hlth Sci Ctr, Winnipeg, MB, Canada

[25] Ctr Hosp Univ Quebec, Ste Foy, PQ, Canada

[26] Kingston Hlth Sci Ctr, Kingston, ON, Canada

[27] Univ Calgary, Foothills Med Ctr, Calgary, AB, Canada

[28] IWK Hlth Ctr, Halifax, NS, Canada

[29] Janeway Childrens Hlth Ctr, St John, NF, Canada

[30] Dr Everett Chalmers Hosp, Fredericton, NB, Canada

[31] Moncton Hosp, Moncton, NB, Canada

[32] St Johns Hosp, St John, NB, Canada

[33] CHU St Justine Hosp, Montreal, PQ, Canada

[34] Jewish Gen Hosp, Montreal, PQ, Canada

[35] Montreal Childrens Hosp, Montreal, PQ, Canada

[36] Hamilton Hlth Sci Ctr, Hamilton, ON, Canada

[37] London Hlth Sci Ctr, London, ON, Canada

[38] Childrens Hosp Eastern Ontario, Ottawa, ON, Canada

[39] Hosp Sick Children, Toronto, ON, Canada

[40] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[41] Windsor Reg Hosp, Windsor, ON, Canada

[42] St Boniface Gen Hosp, Winnipeg, MB, Canada

[43] Regina Gen Hosp, Regina, SK, Canada

[44] Royal Univ Hosp, Saskatoon, SK, Canada

[45] Victoria Gen Hosp, Victoria, BC, Canada

来源：

CANADIAN MEDICAL ASSOCIATION JOURNAL | 2020年 / 192卷 / 04期

基金：

加拿大健康研究院;

关键词：

BIRTH-WEIGHT;

D O I：

10.1503/cmaj.190940

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.

引用

页码：E81 / E91

页数：11

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