Le Réseau Néonatal Canadien - PDF

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BCCH CHUQ SEHC HHSC EDM RVH SBGH SMH SJRH GVS FMC KGH RQHR RUH OTTA HSC MSH MCH SUNY HSJ IWK LHSC RCH ECH JGH JCHC HSCC The Canadian Neonatal Network TM Le Réseau Néonatal Canadien Annual Report 21 Rapport

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BCCH CHUQ SEHC HHSC EDM RVH SBGH SMH SJRH GVS FMC KGH RQHR RUH OTTA HSC MSH MCH SUNY HSJ IWK LHSC RCH ECH JGH JCHC HSCC The Canadian Neonatal Network TM Le Réseau Néonatal Canadien Annual Report 21 Rapport Annuel TM Acknowledgements This report is based upon data collected from 27 individual hospitals from across Canada that were members of the Canadian Neonatal Network during the year 21. In addition to all investigators and the funding agency, we would like to recognize the invaluable support of the Neonatal Intensive Care Units (NICUs) that contributed to this information, the support of all of the participating hospitals and most importantly, the dedication and hard work of the Site Investigators and Data Abstractors. Structure of the CNN The Canadian Neonatal Network (CNN) is a group of Canadian researchers who collaborate on research issues relating to neonatal care. The Network was founded in 1995 by Dr. Shoo Lee. The Network maintains a standardized NICU database and provides a unique opportunity for researchers to participate in collaborative projects on a national and an international scale. Health care professionals, health services researchers, and health care administrators participate actively in clinical, epidemiologic, outcomes, health services, health policy and informatics research aimed at improving effectiveness and efficiency of neonatal care. Research results are published in Network reports and in peer-reviewed journals. Funding The CNN infrastructure is funded by the Canadian Institutes of Health Research. Individual participating hospitals provided additional funding for data collection and other related resources. The Maternal-Infant Care Research Center is supported by funding from the Ministry of Health and Long-Term Care, Ontario. Coordinating Centre of the CNN Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario Network Director: Associate Director: Steering Committee: Study Coordinator: Analyst: Dr. Shoo K. Lee, University of Toronto Dr. Prakesh Shah, University of Toronto Dr. Mary Seshia, University of Manitoba Dr. Kimberly Dow, Queen s University Dr. Wendy Yee, University of Calgary Dr. Christoph Fusch, McMaster University Dr. Adele Harrison, University of British Columbia Dr. Vibhuti Shah, University of Toronto Ms. Martine Claveau, McGill University Ms. Priscilla Chan, Mount Sinai Hospital Mr. Woojin Yoon, Mount Sinai Hospital Report Review Committee: Dr. Alexander Allen, Dalhousie University Ms. Debbie Arsenault, IWK Health Centre Dr. Keith Barrington, University of Montreal Dr. Orlando Da Silva, University of Western Ontario i Participating CNN Sites for the 21 Report: Dr. Michael Dunn, University of Toronto Dr. Arne Ohlsson, University of Toronto Dr. Nicole Rouvinez-Bouali, University of Ottawa Dr. Mary Seshia, University of Manitoba Dr. Nalini Singhal, University of Calgary Dr. Prakesh Shah, University of Toronto (Chair) Dr. Adele Harrison Dr. Anne Synnes Dr. Zenon Cieslak Dr. Todd Sorokan Dr. Wendy Yee Dr. Khalid Aziz Dr. Zarin Kalapesi Dr. Koravangattu Sankaran Dr. Mary Seshia Dr. Gerarda Cronin & Dr. Ruben Alvaro Dr. Sandesh Shivananda Dr. Orlando Da Silva Dr. Andrew James Dr. Prakesh Shah Dr. Michael Dunn Dr. Nicole Rouvinez-Bouali Dr. Kimberly Dow Dr. Lajos Kovacs Dr. Keith Barrington Dr. Bruno Piedboeuf Dr. Patricia Riley Dr. Daniel Faucher Dr. Douglas McMillan Dr. Rody Canning Dr. Barbara Bulleid Dr. Cecil Ojah Dr. Wayne Andrews Victoria General Hospital, Victoria, British Columbia BC Women s Hospital, Vancouver, British Columbia Royal Columbian Hospital, New Westminster, British Columbia Surrey Memorial Hospital, Surrey, British Columbia Foothills Medical Centre, Calgary, Alberta Royal Alexandra Hospital, Edmonton, Alberta Regina General Hospital, Regina, Saskatchewan Royal University Hospital, Saskatoon, Saskatchewan Winnipeg Health Sciences Centre, Winnipeg, Manitoba St. Boniface General Hospital, Winnipeg, Manitoba Hamilton Health Sciences Centre, Hamilton, Ontario London Health Sciences Centre, London, Ontario (formerly St. Joseph s Health Centre) Hospital for Sick Children, Toronto, Ontario Mount Sinai Hospital, Toronto, Ontario Sunnybrook Health Sciences Centre, Toronto, Ontario Children s Hospital of Eastern Ontario, Ottawa, Ontario Kingston General Hospital, Kingston, Ontario Jewish General Hospital, Montréal, Québec Hôpital Sainte-Justine, Montréal, Québec Centre Hospitalier Universitaire de Québec, Sainte Foy, Québec Montréal Children s Hospital, Montréal, Québec Royal Victoria Hospital, Montréal, Québec IWK Health Centre, Halifax, Nova Scotia Moncton Hospital, Moncton, New Brunswick Dr. Everett Chalmers Hospital, Fredericton, New Brunswick Saint John Regional Hospital, Saint John, New Brunswick Janeway Children s Health and Rehabilitation Centre, St. John s, Newfoundland Written & Prepared By: Dr. Prakesh Shah, Dr. Shoo Lee, Woojin Yoon, Priscilla Chan and Members of the Report Review Committee Cover page adapted by Sarah De La Rue and Priscilla Chan istockphoto.com/chuwy ii Table of contents Page A. Executive Summary 1 B. Background & Objectives 3 C. Information Systems 5 D. Descriptive Analyses 6 D.1. Analyses based on number of admissions to participating Canadian NICUs Presentation #1 Admissions to Canadian Neonatal Network participating hospitals 9 Presentation #2 Admission illness severity scores (SNAPII and SNAPIIPE) by hospital 11 D.2. Analyses based on number of neonates admitted to participating Canadian NICUs Presentation #3 Gestational age at birth 14 Presentation #4 Gestational age at birth and survival to NICU discharge 16 Presentation #5 Birth weight 17 Presentation #6 Birth weight and survival to NICU discharge 18 Presentation #7 Maternal characteristics 19 Presentation #8 Resuscitation (GA 31 weeks and GA 31 weeks ) 21 Presentation #9 Early onset sepsis (by GA) 23 Presentation #1 Late onset sepsis (by GA) 24 Presentation #11 Late onset sepsis (by BW) 25 Presentation #12 Other diagnoses / interventions / procedures by GA groups 26 D.3. Analyses based on number of very preterm ( 33 weeks GA) or VLBW ( 15g) neonates Presentation #13 Treatment of patent ductus arteriosus (by GA) 29 Presentation #14 Treatment of patent ductus arteriosus (by BW) 3 Presentation #15 Neuroimaging findings (by GA) 31 Presentation #16 Neuroimaging findings (by BW) 33 Presentation #17 Necrotizing enterocolitis and treatment modalities received (by GA) 35 Presentation #18 Necrotizing enterocolitis and treatment modalities received (by BW) 36 Presentation #19a Oxygen dependency (by GA) among neonates with GA 33 weeks 37 Presentation #19b Any respiratory support (by GA) among neonates with GA 33 weeks 38 Presentation #2a Oxygen dependency (by BW) among neonates with BW 15g 39 Presentation #2b Any respiratory support (by BW) among neonates with BW 15g 4 Presentation #21 Retinopathy of prematurity (by GA) 41 Presentation #22 Retinopathy of prematurity (by BW) 42 Presentation #23 Laser/Anti-VEGF therapy for neonates with retinopathy of prematurity (by GA) 43 Presentation #24 Laser/Anti-VEGF therapy for neonates with retinopathy of prematurity (by BW) 44 Presentation #25a GA specific mortality or significant morbidity (6 morbidities) 45 Presentation #25b GA specific mortality or significant morbidity (3 morbidities) 46 E. Site Comparisons E.1. Site Comparisons - Population Presentation #26 Site-specific GA categories of neonates 49 Presentation #27 Site-specific BW categories of neonates 5 iii E.2. Site Comparisons Survival / Mortality Presentation #28 Site-specific survival rates by GA 52 Presentation #29 Site-specific survival rates by BW 53 Presentation #3 Site comparison of mortality 54 Presentation #31 SNAP-II PE adjusted site mortality rates 55 E.3. Site Comparisons Morbidities & Risks Adjusted Analyses Presentation #32 Late onset sepsis for neonates with GA 33 weeks (site rates) 58 Presentation #33 Late onset sepsis among neonates with GA 33 weeks (site comparison) 59 Presentation #34 Late onset sepsis per 1 patient days for neonates with GA 33 weeks 6 Presentation #35 Late onset sepsis per 1 central catheter days among neonates with GA 33 weeks 61 Presentation #36 Treatment of PDA for neonates with GA 33 weeks 62 Presentation #37 Surgical ligation of PDA for neonates with GA 33 weeks 63 Presentation #38 Neuroimaging abnormalities among neonates 33 weeks GA 64 Presentation #39 Neuroimaging abnormality (VE or PEC) among neonates 33 weeks GA 66 Presentation #4 Necrotizing enterocolitis ( stage 2) for neonates with GA 33 weeks (site rates) 67 Presentation #41 Necrotizing enterocolitis ( stage 2) among neonates with GA 33 weeks (site comparison) 69 Presentation #42 Oxygen dependency at 28 days in neonates with GA 33 weeks at birth 7 Presentation #43 Oxygen dependency at 36 weeks in neonates with GA 33 weeks at birth 71 Presentation #44 Oxygen dependency at 28 days or death in neonates with GA 33 weeks at birth 72 Presentation #45 Oxygen dependency at 36 weeks or death in neonates with GA 33 weeks at birth 73 Presentation #46a Oxygen dependency at 36 weeks post-menstrual age (site comparison) 74 Presentation #46b Oxygen dependency at 28 days after birth (site comparison) 75 Presentation #47a Oxygen dependency at 36 weeks post-menstrual age or death at any time 76 Presentation #47b Oxygen dependency at 28 days after birth or death at any time 77 Presentation #48 Postnatal use of steroids for any indication among neonates with GA 33 weeks 78 Presentation #48a Postnatal use of steroids for treatment of BPD among neonates with GA 33 weeks 79 Presentation #48b Postnatal use of systemic steroids for hypotension among neonates with GA 33 weeks 8 Presentation #49a Retinopathy of prematurity among neonates with BW 1g & survival beyond 6 weeks 81 Presentation #49b Retinopathy of prematurity among neonates with BW 15g and who had eye exams 82 Presentation #5 Treatment for retinopathy of prematurity among neonates with BW 1g 83 Presentation #51 Retinopathy of prematurity stage 3 and higher 84 Presentation #52 Laser/Anti-VEGF therapy for retinopathy of prematurity 85 Presentation #53a Benchmarking for sites which contributed all eligible admission with GA 33 weeks 86 Presentation #53b Benchmarking for sites which contributed all eligible admission with GA 29 weeks 87 F. Discharge Disposition & Status Presentation #54 Discharge destination 89 Presentation #55 Support at discharge 9 G. Duration of Support & Length of Stay Duration of invasive mechanical ventilation for neonates with GA 33 and discharged Presentation #56 home from network hospitals 92 Presentation #57 Duration of invasive mechanical ventilation for neonates with GA Duration of CPAP for neonates with GA 33 and discharged home from network Presentation #58 hospitals 94 Duration of any respiratory support for neonates with GA 33 and discharged home Presentation #59 from network hospitals 95 Duration of oxygen support for neonates with GA 33 and discharged home from Presentation #6 network hospitals 96 iv Duration of TPN for neonates with GA 33 and discharged home from network Presentation #61 hospitals 97 Presentation #62 Duration of TPN for neonates with GA Duration of UV catheter use for neonates with GA 33 and discharged home from Presentation #63 network hospitals 99 Presentation #64 Duration of UV catheter use for neonates with GA 29 1 Duration of IV catheter use for neonates with GA 33 and discharged home from Presentation #65 network hospitals 11 Presentation #66 Length of stay for neonates with GA 33 and discharged home from network hospitals 12 H. Hypoxic Ischemic Encephalopathy Presentation #67 Hypoxic Ischemic Encephalopathy 14 I. Trend Analyses over last 3 years 17 J. Conclusions 117 K. Future Plans 118 v A. Executive Summary A. Executive Summary This report from the Canadian Neonatal Network TM (CNN) is based on data from 27 tertiary NICUs, which contributed data in the year 21. The CNN is funded through the Canadian Institutes of Health Research (CIHR) and the coordinating center at the Maternal- Infant Care Research Center is supported by the Ministry of Health and Long-Term Care, Ontario. The individual centers contribute financially by providing funding for data abstraction. The purposes of the Network are to: Maintain a national neonatal-perinatal database and provide the infrastructure to facilitate collaborative research Provide benchmarking information for Canadian NICUs Maintain a national network of multidisciplinary researchers interested in neonatalperinatal research Longitudinally study outcomes and variations in medical care and Examine the impact of resource utilization and practice patterns on patient outcomes and costs of care Summary of Results/Methodology Canadian Neonatal Network Database: Admissions between January 1, 21 and December 31, 21 who were discharged by March 31, 211 are included. Total number of eligible admissions to participating Canadian NICUs 14 5 (See section D.1 for analyses) Total number of eligible individual neonates (See section D.2. for analyses) Total number of eligible very preterm ( 33 weeks GA) neonates (See section D.3. for analyses) Total number of very low BW (VLBW) neonates 2 89 (See section D.3. for analyses) Total number of small for GA neonates Gestational age (GA) in weeks in this document refers to completed weeks (i.e. 32 weeks include neonates of 32 weeks and days to 32 weeks and 6 days of gestation). Neonates who were transferred to a normal newborn care area (level I nursery) or discharged home within 24 hours of their admission to the NICU were excluded. Data on patient demographics, components of care and outcome until discharge from the participating hospital were entered into a computer and transferred electronically to the Coordinating Centre, at the Maternal-Infant Care Research Centre (MiCare), where the data were verified and analyzed. 1 A. Executive Summary Results presented in this report are comprised of: Section D: Section E: Section F: Section G: Section H: Section I: Descriptive Analyses Site Comparisons Discharge Disposition and Status Duration of Support and Length of Stay Hypoxic Ischemic Encephalopathy Trend Analyses over last 3 years Some sites are limited by funding and therefore are only able to contribute data from a subset of the eligible neonates admitted to their NICU. Characteristics of participating CNN sites are highlighted at the outset of the presentations to provide basic information regarding network hospitals. The missing data on outcome variables vary for each presentation and caution should be used in interpreting the information. 2 B. Background and Objectives B. Background and Objectives Neonatal Intensive Care Units (NICUs) utilize the combined abilities of health care team members in expanding knowledge and advancing the technology to provide effective care of neonates. To support continuous improvement in newborn outcomes of Canadian NICUs, the CNN database provides ordinal and categorical data to identify variations in mortality, morbidity, and resource utilization. The first CNN report saw the validation of a newborn severity score [Score for Acute Neonatal Physiology (SNAPII) 1 ], a severity of illness scale [Neonatal Therapeutic Intervention Scoring System (NTISS) 2 ], and an instrument for assessing neonatal transport outcomes [Transport Risk Index of Physiologic Stability (TRIPS) 3 ]. The use of these three scores permitted benchmarking of risk-adjusted variations in mortality and morbidity among Canadian NICUs. This demonstrated variations in outcomes and practices among Canadian NICUs, and indicated that different hospitals had different strengths as well as areas requiring improvement. The results suggested that practice and outcome variations are associated, and led to the inception of an additional research project investigating the targeting of specific practices for change in order to improve outcomes in NICUs across Canada. The Evidence-based Practice for Improving Quality (EPIQ1) project explored new methodologies for identifying care practices associated with good or poor outcomes, and provided an evidence-based approach to improving quality of care. Building upon traditional continuous quality improvement techniques, EPIQ1 used multidisciplinary teams at CNN sites, who worked collaboratively to implement best practice changes. Results of this study were recently published. 1 The second version of this project, EPIQ2, is currently ongoing in NICUs across Canada. Research using the data was overseen by a Steering Committee, which was elected by members of the Canadian Neonatal Network. Separate ethics approvals were obtained from the participating institutions for specific projects. Studies conducted by the CNN researchers are supported by the Neonatal-Perinatal Interdisciplinary Capacity Enhancement (NICE) Team, comprising leading researchers from across Canada. Background information regarding participating CNN sites is reported in the following page. 1 Shoo K. Lee et al. Improving the quality of care for neonates: a cluster randomized controlled trial. Can. Med. Assoc. J., Oct 29; 181: CNN Site Characteristics B. Background and Objectives Site Level II / step-down nursery? Level II data included in CNN? All GA/BW? CNN data collection Specific GA Specific BW Pediatric surgeries other than ROP/PDA? ROP surgery? BCCH Yes Yes Yes Yes Yes Yes CHUQ Yes No No 29 weeks Yes Yes Yes ECH Yes Yes Yes No No No EDM Yes Yes No 33 weeks Yes Yes Yes FMC Yes Yes Yes No Yes No GVS Yes Yes Yes Yes Yes Yes HHSC Yes No Yes Yes Yes Yes HSC No No Yes Yes Yes Yes HSCC Yes Yes Yes Yes Yes Yes HSJ Yes Yes Yes Yes Yes Yes IWK Yes Yes Yes Yes Yes Yes JCHC Yes Yes Yes Yes Yes Yes JGH Yes Yes Yes No No No KGH Yes Yes Yes Yes No Yes LHSC Yes Yes Yes Yes Yes Yes MCH N o No No 29 weeks Yes Yes Yes MSH Yes Yes Yes No No No OTTA Yes Yes No 33 weeks Yes Yes Yes RCH Yes Yes Yes Yes No Yes RQHR Yes Yes Yes No No Yes RUH Yes Yes Yes Yes Yes Yes RVH Yes Yes Yes N o N o Yes SBGH No No Yes Yes Yes Yes SEHC No No Yes No No No SJRH No No Yes No No No SUNY No No Yes No No No SMH Yes Yes No Yes No No PDA surgery? 4 C. Information Systems C. Information Systems Neonates included in this report are those who were admitted to a CNN participating site between January 1, 21 and December 31, 21, and were discharged by March 31, 211. The neonates must have had a length of stay in the NICU of one of the CNN participating sites for greater than or equal to 24 hours, or died or were transferred to another level 2 or 3 facility within 24 hours. A total of patients accounted for 14 5 admissions as some neonates were admitted on more than one occasions. Patient information was retrospectively abstracted from patient charts by trained personnel using standard definitions and protocols contained in a standard manual of operations. Data were usually entered into a laptop computer using a customized data entry program with built-in error checking and subsequently sent electronically to the Canadian Neonatal Network Coordinating Centre, located at the Maternal-Infant Care Research Centre (MiCare) in Toronto, Ontario. Patient data at each participating NICU are available to the respective site investigator and data abstractor only. Patient identifiers were stripped prior to data transfer to the Coordinating Centre. Patient confidentiality was strictly observed. Individual-level data are used for analyses, but only aggregate data are reported. The results presented in this report will not identify participating NICUs by name; each site is anonymous using a randomly assigned number. Wherever a small cell size ( 5) was observed in the data output, the data were often grouped to maintain anonymity. At each participating NICU, data are stored in a secured database in the NICU or in an alternate secured site used by the NICU to store patient information (e.g. health
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