Journal article
Clinical burden associated with therapies for cardio-pulmonary critical decompensation in preterm neonates across Canadian neonatal intensive care units
European journal of pediatrics, Vol.181(9), pp.3319-3330
09/01/2022
DOI: 10.1007/s00431-022-04508-6
PMID: 35779092
Abstract
The aim of this retrospective cohort study was to study the clinical burden associated with cardio-pulmonary critical decompensations (CPCDs) in preterm neonates and factors associated with mortality. Through the Canadian Neonatal Network (30 tertiary NICUs, 2010-2017), we identified infants < 32-week gestational age with CPCDs, defined by "significant exposure" to cardiotropes and/or inhaled nitric oxide (iNO): (1) either therapy for >= 3 consecutive days, (2) both for >= 2 consecutive days, or (3) any exposure within 2 days of death. Early CPCDs (<= 3 days of age) and late CPCDs (> 3 days) were examined separately. Outcomes included CPCD-incidence, mortality, and inter-site variability using standardized ratios (observed/adjusted expected rate) and network funnel plots. Mixed-effects analysis was used to quantify unit-level variability in mortality. Overall, 10% of admissions experienced CPCDs (n = 2915). Late CPCDs decreased by similar to 5%/year, while early CPCDs were unchanged during the study period. Incidence and CPCD-associated mortality varied between sites, for both early (0.6-7.5% and 0-100%, respectively) and late CPCDs (2.5-15% and 14-83%, respectively), all p < 0.01. Units' late-CPCD incidence and mortality demonstrated an inverse relationship (slope= -2.5, p < 0.01). Mixed-effects analysis demonstrated clustering effect, with 6.4% and 8.6% of variability in mortality after early and late CPCDs respectively being site-related, unexplained by available patient-level characteristics or unit volume. Mortality was higher with combined exposure than with only-cardiotropes or only-iNO (41.3%, 24.8%, 21.5%, respectively; p < 0.01).
Conclusions: Clustering effects exist in CPCD-associated mortality among Canadian NICUs, with higher incidence units showing lower mortality. These data may aid network-level benchmarking, patient-level risk stratification, parental counseling, and further research and quality improvement work.
Details
- Title: Subtitle
- Clinical burden associated with therapies for cardio-pulmonary critical decompensation in preterm neonates across Canadian neonatal intensive care units
- Creators
- Ashraf Kharrat - University of TorontoPatrick J. McNamara - University of IowaDany E. Weisz - Sunnybrook Health Science CentreEdmond Kelly - Mount Sinai HospitalEdith Masse - Université de SherbrookeAmit Mukerji - McMaster UniversityDeepak Louis - University of ManitobaJehier Afifi - Dalhousie UniversityXiang Y. Ye - Mount Sinai HospitalPrakesh S. Shah - University of TorontoAmish Jain - Mount Sinai HospitalCanadian Neonatal Network
- Resource Type
- Journal article
- Publication Details
- European journal of pediatrics, Vol.181(9), pp.3319-3330
- Publisher
- Springer Nature
- DOI
- 10.1007/s00431-022-04508-6
- PMID
- 35779092
- ISSN
- 0340-6199
- eISSN
- 1432-1076
- Number of pages
- 12
- Language
- English
- Date published
- 09/01/2022
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984354035302771
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