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Variations in early and intermediate neonatal outcomes for inborn infants admitted to a Canadian NICU and born of hypertensive pregnancies.

Hayter, MA; Anderson, L; Claydon, J; Magee, LA; Liston, RM; Lee, SK; von Dadelszen, P; Canadian Neonatal Network, CNN (2005) Variations in early and intermediate neonatal outcomes for inborn infants admitted to a Canadian NICU and born of hypertensive pregnancies. Journal of Obstetrics and Gynaecology Canada, 27 (1). pp. 25-32. ISSN 1701-2163 https://doi.org/10.1016/S1701-2163(16)30168-2
SGUL Authors: von Dadelszen, Peter

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Abstract

OBJECTIVE: To determine whether neonatal intensive care unit (NICU) outcomes vary by centre for inborn neonates of hypertensive pregnancies and, if so, whether that variation might be related to between-centre variations in obstetric practice. METHODS: The study comprised a prospective cohort of 13 505 singleton neonates admitted to 17 Canadian NICUs. Adjusting for potential confounders, we used multivariate regression to analyze the relation between centre of delivery and 6 dependent variables: (1) Apgar score < 7 at 5 minutes; (2) Score of Neonatal Acute Physiology-II (SNAP-II) score > or = 10; (3) neonatal death; (4) neonatal death or morbidity (owing to bronchopulmonary dysplasia [BPD], intraventricular hemorrhage [IVH], necrotizing enterocolitis [NEC], persistent ductus arteriosus [PDA], or periventricular leukomalacia [PVL]); (5) BPD alone; and (6) major neonatal morbidity (that is, at least one of IVH, PVL, NEC, or PDA). NICU practices known to influence these outcomes were included in the modelling for neonatal death and neonatal morbidity. In a sensitivity analysis for practice variation, antenatal steroid exposure was both included and excluded in each regression. RESULTS: For 5 of the 6 dependent variables, we identified between-centre variation that was not explained solely by variation in antenatal corticosteroid use. Adjusted odds ratios varied from 0.11 to 5.6 (the reference centre was the median rate of the adverse outcome). CONCLUSIONS: In the pregnancy hypertension setting, between-centre variations in practice are associated with variations in neonatal physiology and survival. For infants admitted to NICU, the obstetric management of hypertensive pregnancies appears to have an effect on both short- and medium-term neonatal outcomes, even after correction for NICU management.

Item Type: Article
Additional Information: © 2005 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved. Made available with permission from the publisher. Contact publisher for any further re-use.
Keywords: Adrenal Cortex Hormones, Apgar Score, Canada, Cohort Studies, Female, Humans, Hypertension, Pregnancy-Induced, Infant Mortality, Infant, Newborn, Infant, Newborn, Diseases, Intensive Care Units, Neonatal, Intensive Care, Neonatal, Morbidity, Odds Ratio, Pregnancy, Prospective Studies, Canadian Neonatal Network, Humans, Hypertension, Pregnancy-Induced, Infant, Newborn, Diseases, Adrenal Cortex Hormones, Apgar Score, Intensive Care, Neonatal, Morbidity, Infant Mortality, Odds Ratio, Cohort Studies, Prospective Studies, Pregnancy, Infant, Newborn, Intensive Care Units, Neonatal, Canada, Female, 1114 Paediatrics And Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Journal of Obstetrics and Gynaecology Canada
ISSN: 1701-2163
Language: eng
Dates:
DateEvent
1 January 2005Published
Publisher License: Publisher's own licence
PubMed ID: 15937579
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107540
Publisher's version: https://doi.org/10.1016/S1701-2163(16)30168-2

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