Abstract
Objective To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. Study design We included 58 004 infants born weighing <1500 g at 240–316 weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. Results Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. Conclusions We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
| Original language | English |
|---|---|
| Pages (from-to) | 144-152.e6 |
| Journal | Journal of Pediatrics |
| Volume | 177 |
| DOIs | |
| Publication status | Published - 2016 |
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In: Journal of Pediatrics, Vol. 177, 2016, p. 144-152.e6.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates
T2 - An International Comparison
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AU - Díaz, María Fernández
AU - Pérez Rodríguez, Jesús
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AU - González, Javier Vilas
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AU - Kasemo, Anna
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AU - Ingemarsson, Fredrik
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AU - Wejryd, Erik
AU - Kuusima-Löfbom, Johanna
AU - Lund, Ellen Elisabeth
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AU - Sjöberg, Kenneth
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AU - Currie, Andrew
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AU - Manzoor, Azhar
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AU - Simmons, Phil
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AU - Munyard, Paul
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AU - Raman, Mala
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AU - Amess, Philip
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AU - Misra, Indranil
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AU - De Halpert, Peter
AU - Salgia, Sanjay
AU - Sanghavi, Rekha
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AU - Deketelaere, Abby
AU - Khashu, Minesh
AU - Hall, Michael
AU - Groves, Charlotte
AU - Brown, Nick
AU - Brennan, Nick
AU - Vamvakiti, Katia
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AU - Mannix, Paul
AU - Harding, David
AU - Eaton, Megan
AU - Schwarz, Karin
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AU - Miall, Lawrence
AU - Gibson, David
N1 - Publisher Copyright: © 2016 Elsevier Inc.
PY - 2016
Y1 - 2016
N2 - Objective To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. Study design We included 58 004 infants born weighing <1500 g at 240–316 weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. Results Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. Conclusions We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
AB - Objective To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. Study design We included 58 004 infants born weighing <1500 g at 240–316 weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. Results Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. Conclusions We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
KW - bronchopulmonary dysplasia
KW - composite outcome
KW - peri-intraventricular hemorrhage
KW - periventricular echodensity/echolucency
KW - preterm birth
KW - quality improvement
KW - retinopathy of prematurity
UR - http://www.scopus.com/inward/record.url?scp=84971632069&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2016.04.083
DO - 10.1016/j.jpeds.2016.04.083
M3 - Article
SN - 0022-3476
VL - 177
SP - 144-152.e6
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -