The Canadian Neonatal Network Le Réseau Néonatal Canadien - PDF

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

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SEHC IWK LHSC EDM OTTA RCH SJRH JCHC HSC MSH RVH CHUS SUNY CHUQ SMH JGH SBGH MCH HHSC KGH HSCC ECH WRH FMC RUH GVS BCWH CBRH RQHR HSJ The Canadian Neonatal Network Le Réseau Néonatal Canadien Annual Report 212 Rapport Annuel TM TM Acknowledgements This report is based upon data collected from 3 Health Care Organizations from across Canada that were members of the Canadian Neonatal Network during the year 212. 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 sites 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 neonatal database and provides unique opportunities 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 quality, 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 sites 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 Chairman: Network Director: Executive Committee: CNN Coordinator: Analyst: Dr. Shoo K. Lee, University of Toronto Dr. Prakesh Shah, University of Toronto Ms. Martine Claveau, McGill University Dr. Kimberly Dow, Queen s University Dr. Christoph Fusch, McMaster University Dr. Adele Harrison, University of British Columbia Dr. Abhay Lodha, University of Calgary Dr. Vibhuti Shah, University of Toronto Dr. Wendy Yee, University of Calgary Ms. Vinthiya Param, Mount Sinai Hospital Mr. Eugene W. Yoon, Mount Sinai Hospital i Report Review Committee: Dr. Alexander Allen, Dalhousie University Dr. Keith Barrington, University of Montreal Dr. Orlando Da Silva, University of Western Ontario Dr. Michael Dunn, University of Toronto Dr. Arne Ohlsson, University of Toronto Dr. Nicole Rouvinez-Bouali, University of Ottawa Ms. Wendy Seidlitz, Hamilton Health Sciences Dr. Mary Seshia, University of Manitoba Dr. Prakesh Shah, University of Toronto (Chair) Dr. Nalini Singhal, University of Calgary Participating CNN Sites and Site Investigators for the 212 Report: Victoria General Hospital, Victoria, British Columbia Dr. Adele Harrison BC Women s Hospital, Vancouver, British Columbia Dr. Anne Synnes Royal Columbian Hospital, New Westminster, Dr. Zenon Cieslak British Columbia Surrey Memorial Hospital, Surrey, British Columbia Dr. Todd Sorokan Foothills Medical Centre, Calgary, Alberta Dr. Wendy Yee Royal Alexandra Hospital, Edmonton, Alberta Dr. Khalid Aziz University of Alberta Hospital Stollery Children's, Edmonton, Alberta Royal University Hospital, Saskatoon, Saskatchewan Dr. Koravangattu Sankaran Regina General Hospital, Regina, Saskatchewan Dr. Zarin Kalapesi Winnipeg Health Sciences Centre, Winnipeg, Manitoba Dr. Mary Seshia St. Boniface General Hospital, Winnipeg, Manitoba Dr. Ruben Alvaro Windsor Regional Hospital, Windsor, Ontario Dr. Chuks Nwaesei London Health Sciences Centre, London, Ontario Dr. Orlando Da Silva Hamilton Health Sciences, Hamilton, Ontario Dr. Sandesh Shivananda Mount Sinai Hospital, Toronto, Ontario Dr. Prakesh Shah Hospital for Sick Children, Toronto, Ontario Dr. Kyong-Soon Lee Sunnybrook Health Sciences Centre, Toronto, Ontario Dr. Michael Dunn Kingston General Hospital, Kingston, Ontario Dr. Kimberly Dow Children s Hospital of Eastern Ontario, Ottawa, Ontario Dr. Nicole Rouvinez-Bouali Ottawa General Hospital, Ottawa, Ontario Jewish General Hospital, Montréal, Québec Dr. Lajos KovacsRoyal Hôpital Sainte-Justine, Montréal, Québec Dr. Keith Barrington Montréal Children s Hospital, Montréal, Québec Dr. Patricia Riley Centre Hospitalier Universitaire de Québec, Sainte Foy, Dr. Bruno Piedboeuf Québec Victoria Hospital, Montréal, Québec Dr. Daniel Faucher Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Dr. Valerie Bertelle Québec Dr. Everett Chalmers Hospital, Fredericton, New Brunswick Dr. Barbara Bulleid Saint John Regional Hospital, Saint John, New Brunswick Dr. Cecil Ojah/ Dr. Luis Monterrosa Moncton Hospital, Moncton, New Brunswick Dr. Rody Canning ii IWK Health Centre, Halifax, Nova Scotia Cape Breton Regional Hospital, Sydney, Nova Scotia Janeway Children s Health and Rehabilitation Centre, St. John s, Newfoundland Dr. Douglas McMillan Dr. Andrzej Kajetanowicz Dr. Wayne Andrews Written & Prepared By: Dr. Prakesh Shah, Dr. Shoo Lee, Eugene W. Yoon, Vinthiya Param and Members of the Annual Report Review Committee Cover page adapted by Vinthiya Param and Ruth Warre iii Table of contents Page List of Abbreviations 1 A. Executive Summary 3 B. Background & Objectives 5 CNN Site Characteristics 6 C. Information Systems 7 D. Descriptive Analyses 8 D.1. Analyses based on number of admissions to participating Canadian sites Presentation #1 Admissions to Canadian Neonatal Network participating sites 11 Presentation #2 Admission illness severity scores (SNAP-II and SNAP-IIPE) by site 13 D.2. Analyses based on number of neonates admitted to participating Canadian sites Presentation #3 Gestational age at birth 15 Presentation #4 Gestational age at birth and survival to discharge 18 Presentation #5 Birth weight distribution 19 Presentation #6 Birth weight and survival to discharge 2 Presentation #7 Maternal characteristics 21 Presentation #8 Resuscitation (GA 31 weeks and GA 31 weeks) 23 Presentation #9 Early onset sepsis (by GA) 25 Presentation #1 Late onset sepsis (by GA) 26 Presentation #11 Late onset sepsis (by BW) 27 Presentation #12 Other diagnoses / interventions / procedures by GA groups 28 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) 31 Presentation #14 Treatment of patent ductus arteriosus (by BW) 32 Presentation #15 Neuroimaging findings (by GA) 33 Presentation #16 Neuroimaging findings (by BW) 35 Presentation #17 Necrotizing enterocolitis and treatment modalities received (by GA) 37 Presentation #18 Necrotizing enterocolitis and treatment modalities received (by BW) 38 Presentation #19a Oxygen use (by GA) among neonates with GA 33 weeks 39 Presentation #19b Any respiratory support (by GA) among neonates with GA 33 weeks 4 Presentation #2a Oxygen use (by BW) among neonates with BW 15g 41 Presentation #2b Any respiratory support (by BW) among neonates with BW 15g 42 Presentation #21 Retinopathy of prematurity (by GA) 43 Presentation #22 Retinopathy of prematurity (by BW) 44 Presentation #23 Laser/Anti-VEGF therapy for neonates with retinopathy of prematurity (by GA) 45 Presentation #24 Laser/Anti-VEGF therapy for neonates with retinopathy of prematurity (by BW) 46 Presentation #25a GA specific mortality or significant morbidity (6 morbidities) 47 Presentation #25b GA specific mortality or significant morbidity (3 morbidities) 48 D.4 Analyses based on number of neonates who are small for gestational age (BW 1 th centile for GA) Presentation #26 Characteristics and outcomes of SGA infants 5 iv E. Site Comparisons E.1. Site Comparisons - Population Presentation #27 Site-specific GA categories of neonates 53 Presentation #28 Site-specific BW categories of neonates 54 E.2. Site Comparisons Survival / Mortality Presentation #29 Site-specific survival rates by GA 56 Presentation #3 Site-specific survival rates by BW 57 Presentation #31 Site comparison of mortality 58 Presentation #32 SNAP-II PE standardized site mortality rates 59 E.3. Site Comparisons Morbidities & Risks Adjusted Analyses Presentation #33 Site specific morbidities among GA 33 weeks 62 Presentation #34 Site specific morbidities among GA 29 weeks 63 Presentation #35 Late onset sepsis for neonates with GA 33 weeks (site rates) 64 Presentation #36 Late onset sepsis among neonates with GA 33 weeks (site comparison) 65 Presentation #37 Late onset sepsis per 1 patient days for neonates with GA 33 weeks 66 Presentation #38 Late onset sepsis per 1 central catheter days among neonates with GA 33 weeks 67 Presentation #39 Treatment of PDA for neonates with GA 33 weeks 68 Presentation #4 Surgical ligation of PDA for neonates with GA 33 weeks 69 Presentation #41 Neuroimaging abnormalities among neonates 33 weeks GA 7 Presentation #42 Neuroimaging abnormality (VE or PEC) among neonates 33 weeks GA 72 Presentation #43 Necrotizing enterocolitis ( stage 2) for neonates with GA 33 weeks (site rates) 73 Presentation #44 Necrotizing enterocolitis ( stage 2) among neonates with GA 33 weeks (site comparison) 75 Presentation #45 Oxygen use at 28 days in neonates with GA 33 weeks at birth 76 Presentation #46 Oxygen use at 36 weeks in neonates with GA 33 weeks at birth 77 Presentation #47 Oxygen use at 28 days or death in neonates with GA 33 weeks at birth 78 Presentation #48 Oxygen use at 36 weeks or death in neonates with GA 33 weeks at birth 79 Presentation #49a Oxygen use at 36 weeks post-menstrual age (site comparison) 8 Presentation #49b Oxygen use at 28 days after birth (site comparison) 81 Presentation #5a Oxygen use at 36 weeks post-menstrual age or death at any time 82 Presentation #5b Oxygen use at 28 days after birth or death at any time 83 Presentation #51 Postnatal use of steroids for any indication among neonates with GA 33 weeks 84 Presentation #51a Postnatal use of steroids for treatment of BPD among neonates with GA 33 weeks 85 Presentation #51b Postnatal use of systemic steroids for hypotension among neonates with GA 33 weeks 86 Presentation #52a Retinopathy of prematurity among neonates with BW 1g & survival beyond 6 weeks 87 Presentation #52b Retinopathy of prematurity among neonates with BW 15g & who had eye exams 88 Presentation #53 Treatment for retinopathy of prematurity among neonates with BW 1g 89 Presentation #54 Retinopathy of prematurity stage 3 and higher 9 Presentation #55 Laser/Anti-VEGF therapy for retinopathy of prematurity 91 Presentation #56a Benchmarking for sites which contributed all eligible admission with GA 33 weeks 92 Presentation #56b Benchmarking for sites which contributed all eligible admission with GA 29 weeks 94 F. Discharge Disposition & Status Presentation #57 Discharge destination 97 Presentation #58 Support at discharge 98 v G. Duration of Support & Length of Stay Presentation #59 Days of invasive mechanical ventilation (GA 33) 1 Presentation #6 Days of invasive mechanical ventilation (GA 29) 11 Presentation #61 Days of CPAP (GA 33) 12 Presentation #62 Days of any respiratory support (GA 33) 13 Presentation #63 Days of oxygen support (GA 33) 14 Presentation #64 Days of TPN (GA 33) 15 Presentation #65 Days of TPN (GA 29) 16 Presentation #66 Days of UV catheter use (GA 33) 17 Presentation #67 Days of UV catheter use (GA 29) 18 Presentation #68 Days of IV catheter use (GA 33) 19 Presentation #69 Length of stay (GA 33) 11 H. Hypoxic Ischemic Encephalopathy Presentation #7 Hypoxic Ischemic Encephalopathy 112 I. Trend Analyses over last 3 years 115 J. Conclusions 126 K. CNN publications Manuscripts 127 Abstracts 128 L. Future Plans 13 M. Appendix Major anomalies list 131 vi List of Abbreviations List of Abbreviations BW CONS CPAP CVL EPIQ ETT GA GBS GM HFV HIE ICROP IPPV IVH NEC NI NICE NICU NTISS PEC PICC PIV PMA PPV RDS ROP SD SEM SGA SNAP Birth Weight Coagulase-Negative Staphylococcus Continuous Positive Airway Pressure Central Venous Line Evidence-based Practice for Improving Quality Endotracheal Tube Gestational Age Group B Streptococcus Germinal Matrix High Frequency Ventilation Hypoxic Ischemic Encephalopathy International Classification of Retinopathy of Prematurity Intermittent Positive Pressure Ventilation Intra-Ventricular Hemorrhage Necrotizing Enterocolitis Non-Invasive Neonatal-Perinatal Interdisciplinary Capacity Enhancement Neonatal Intensive Care Units Neonatal Therapeutic Intervention Scoring System Parenchymal Echodensities Peripherally Inserted Central Catheters Peripheral Intravenous Postmenstrual Age Positive Pressure Ventilation Respiratory Distress Syndrome Retinopathy of Prematurity Standard Deviation Standard Error of Mean Small for Gestational Age Score for Acute Neonatal Physiology 1 List of Abbreviations SNAP-IIPE Score for Acute Neonatal Physiology Version II, Perinatal Extension TPN Total Parenteral Nutrition TRIPS Transport Risk Index of Physiologic Stability UV Umbilical Vein VE Ventricular Enlargement VEGF Vascular Endothelial Growth Factor VLBW Very Low Birth Weight VP Ventriculoperitoneal Definitions A list of the CNN definitions can be found in the CNN abstractors manual. The manual can be accessed on the CNN website (www.canadianneonatalnetwork.org/portal) at the following link: %3d&tabid=69 2 A. Executive Summary A. Executive Summary This report from the Canadian Neonatal Network TM (CNN) is based on data from 31 tertiary sites, which contributed data in the year 212. The CNN is funded through the Canadian Institutes of Health Research 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 sites 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 Act on variations by informing anonymized results to sites and establishing benchmark for future quality improvement initiatives Summary of Results/Methodology Canadian Neonatal Network Database: Admissions between January 1, 212 and December 31, 212 who were discharged by March 31, 213 are included. Total number of eligible admissions to participating Canadian sites (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 4 37 (See section D.3. for analyses) Total number of eligible very low birth weight (VLBW) neonates (See section D.3. for analyses) Total number of small for gestational age (SGA) neonates (See section D.4. for analysis) Neonates who were transferred to a normal newborn care area (level I nursery) or discharged home within 24 hours of their admission to the site were excluded. Data on patient demographics, components of care and outcome until discharge from the participating site 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. 3 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 Five sites during 212 were limited by funding and therefore were only able to contribute data from a subset of the eligible neonates admitted to their sites. Characteristics of participating CNN sites are highlighted at the outset of the presentations to provide basic information regarding network sites. The missing data on outcome variables vary for each presentation and caution should be used in interpreting the information. All reported percentages used in this report use denominator as neonates for whom data for that particular item were available. 4 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 sites, 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 (SNAP-II) 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 sites. This demonstrated variations in outcomes and practices among Canadian sites, and indicated that different sites had different strengths as well as areas that should be targeted for 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 sites across Canada. The first 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 published in The second version of this project, EPIQ2, is currently ongoing in sites across Canada. This project is targeting quality improvement in all five major morbidities of preterm infant and will also link it with neurodevelopmental outcome up at 2 years of age. Neonatal component of study is completed and follow up data collection is ongoing. Research using the data was overseen by the Executive Committee, which was elected by members of the Canadian Neonatal Network. Separate ethics approvals were obtained from the participating institutions for specific projects as indicated. 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: SITE CNN Site Characteristics CNN data collection criteria Level II / Stepdown nursery? B. Background and Objectives Level II / Stepdown data included in CNN? Delivery room deaths included in CNN 212 data ROP surgical / laser service? Victoria General Hospital All eligible admissions y y y y y Children's & Women's Health Centre of BC All eligible admissions y n n y y Royal Columbian Hospital All eligible admissions y y y y n Surrey Memorial Hospital All eligible admissions y y y n n Foothills Medical Centre All eligible admissions n n/a n y y Royal Alexandra Hospital (Edmonton) * 33 weeks GA & all HIE y y y y n University of Alberta Hospital - Stollery (Edmonton) * All eligible admissions n n/a n/a n y Regina General Hospital All eligible admissions y y y n n Royal University Hospital All eligible admissions n n/a n n y Health Sciences Centre Winnipeg Al
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