Vermont Oxford Network Database Research Articles

Survival and characteristics of retinopathy of prematurity in micro-premature infants

ObjectiveTo describe the risk and nature of retinopathy of prematurity (ROP) in micro-premature infants (≤26 weeks’ gestational age [GA]). MethodsRetrospective analysis of prospectively collected data from infants born at 22–26 weeks’ GA over a 5-year period. ResultsA total of 502 infants were identified, of whom 414 survived to discharge (82.5%). The Vermont Oxford Network database documented clinical follow-up data and ROP outcomes for all 414 patients; complete ROP clinical records were available for 294 of the infants who survived (70.8%). Forty infants were born between 22 and 23 weeks’ GA (group A, 13.6%), and 254 were born between 24 and 26 weeks’ GA (group B, 86.4%). Survival for group A infants was worse than that of group B infants (66.2% vs 85.4%; p < 0.01). Survival of group A infants improved during the study period (R2 = 0.625). Overall, 59.9% of infants developed any ROP and 8.5% developed type 1 ROP. Group A infants were more likely to develop ROP (90.0% vs 48.6%; p < 0.01) and type 1 ROP (30.0% vs 5.1%; p < 0.01) than group B infants. Group A infants developed ROP at an earlier age (32 + 6 weeks vs 33 + 3 weeks; p = 0.02) and were more likely to have zone I disease on presentation (65.0% vs 20.5%; p < 0.01), but there was no difference in the corrected gestational age of peak severity of ROP (35 + 2 weeks vs 34 + 5 weeks; p = 0.36). ConclusionThe most premature infants, born at 22–23 weeks’ GA, develop ROP at an earlier age, are more likely to present with posterior disease, and have a high risk of disease requiring treatment.

Neonatal Admission Temperature in Middle- and High-Income Countries.

Despite being preventable, neonatal hypothermia remains common. We hypothesized that the proportion of newborns with hypothermia on admission would be high in all settings, higher in hospitals in middle-income countries (MIC) compared with high-income countries (HIC), and associated with morbidity and mortality. Using the Vermont Oxford Network database of newborns with birth weights 401 to 1500 g or 22 to 29 weeks' gestational age from 2018 to 2021, we analyzed maternal and infant characteristics, delivery room management, and outcomes by temperature within 1 hour of admission to the NICU in 12 MICs and 22 HICs. Among 201 046 newborns, hypothermia was more common in MIC hospitals (64.0%) compared with HIC hospitals (28.6%). Lower birth weight, small for gestational age status, and prolonged resuscitation were perinatal risk factors for hypothermia. The mortality was doubled for hypothermic compared with euthermic newborns in MICs (24.7% and 15.4%) and HICs (12.7% and 7.6%) hospitals. After adjusting for confounders, the relative risk of death among hypothermic newborns compared with euthermic newborns was 1.21 (95% confidence interval 1.09-1.33) in MICs and 1.26 (95% confidence interval 1.21-1.31) in HICs. Every 1°C increase in admission temperature was associated with a 9% and 10% decrease in mortality risk in MICs and HICs, respectively. In this large sample of newborns across MICs and HICs, hypothermia remains common and is strongly associated with mortality. The profound burden of hypothermia presents an opportunity for strategies to improve outcomes and achieve the neonatal 2030 Sustainable Development Goal.

Variation and Temporal Trends in Delivery Room Management of Moderate and Late Preterm Infants.

Although delivery room (DR) intervention decreases with increasing gestational age (GA), little is known about DR management of moderate and late preterm (MLP) infants. Using the Vermont Oxford Network database of all NICU admissions, we examined the receipt of DR interventions including supplemental oxygen, positive pressure ventilation, continuous positive airway pressure, endotracheal tube ventilation, chest compressions, epinephrine, and surfactant among MLP infants (30 to 36 weeks') without congenital anomalies born from 2011 to 2020. Pneumothorax was examined as a potential resuscitation-associated complication. Intervention frequency was assessed at the infant- and hospital-level, stratified by GA and over time. Overall, 55.3% of 616 110 infants (median GA: 34 weeks) from 483 Vermont Oxford Network centers received any DR intervention. Any DR intervention frequency decreased from 89.7% at 30 weeks to 44.2% at 36 weeks. From 2011 to 2020, there was an increase in the provision of continuous positive airway pressure (17.9% to 47.8%, P ≤.001) and positive pressure ventilation (22.9% to 24.9%, P ≤.001) and a decrease in endotracheal tube ventilation (6.9% to 4.0% P ≤.001), surfactant administration (3.5% to 1.3%, P ≤.001), and pneumothorax (1.9% to 1.6%, P ≤.001). Hospital rates of any DR intervention varied (median 54%, interquartile range 47% to 62%), though the frequency was similar across hospitals with different NICU capabilities after adjustment. The DR management of MLP infants varies at the individual- and hospital-level and is changing over time. These findings illustrate the differing interpretation of resuscitation guidelines and emphasize the need to study MLP infants to improve evidence-based DR care.

Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study

The benefits of human milk for hospitalized preterm infants are well documented, but the extent to which current human milk diets adequately support growth is uncertain. 1) To quantify differences in weight gain and head growth between very preterm infants fed human milk compared with infant formula; and 2) to describe trends in the magnitude of these differences over time. We studied infants from 777 US NICUs in the Vermont Oxford Network database. We included all surviving infants 23-29 weeks of gestation or 401-1500 g birth weight (maximum gestational age 32 wk) and excluded infants discharged >42 weeks of gestation or with congenital anomalies. In diet-growth analyses, we included infants born 2012-2016 (n=138,703) to reflect current practice. In trend analyses, we included a 10-y cohort (n=263,367). We categorized diet at NICU discharge/transfer as: 1) human milk only (no formula or fortifier); 2) human milk with formula or fortifier (mixed); or 3) infant formula only. Outcomes were weight and head circumference z-score change from birth to discharge relative to a fetal reference. Diet at discharge/transfer was human milk only for 18,274 (6.6%), mixed for 121,621 (44%), and formula only for 137,067 (49%). Weight deviated more from the fetal reference for infants fed both human milk diets compared with formula only (weight z-score change for infants fed human milk only, -0.88; mixed, -0.82; formula only -0.80; P<0.0001 for diet overall). There were also differences by diet in head z-score change (human milk only, -0.52; mixed, -0.49; formula only, -0.45; P<0.0001 for diet overall). The magnitude of these differences has diminished substantially over 10y. Very preterm infants receiving human milk compared with infant formula diets have a slower weight gain and head growth at hospital discharge.

Is Early Surfactant Administration Associated with Reduced Mortality in the Late Preterm Infant?

Background: The late preterm infant is at great risk of neglect because it is perceived as near term, however this group suffers from disease due to prematurity and needs great attention. Surfactant use is a well-established intervention that improves outcomes in preterm infants however the timing of its use in this group is not well studied. Objective: To assess whether administration of surfactant within 30 min of birth when clinically indicated reduces mortality in the late preterm infant, and to compare rates of early surfactant use and mortality to international trends using the Vermont Oxford Network database. Methods: This was a retrospective study conducted at private neonatal ICU in Gauteng, where data were collected from 2002 to 2013. Data on mortality and surfactant use were compiled using the online database called the Vermont Oxford Network. Comparisons were then made between the periods where surfactant was administered early and when they were not. Results: A total of 3040 cases were retrieved over the study period 2002 to 2013. The mean age of the population was 35-1/7 weeks and the mean birth weight was 2222.32 grams. During the study period, early surfactant administration rose to 90.62% compared to the VON which was averaged at 32.53%. Mortality dropped from 3.12% to 0.39% during the interventional period. This was significantly lower than the VON's mortality of 1.21% (p<0.05). A strong inverse correlation between early surfactant use and mortality was observed with the Pearson correlation coefficient being -0.86 (p<0.05). Conclusion: This study showed that for the late preterm infant, early surfactant use within 30 minutes of birth was significantly higher at the study center than international trends. It also demonstrated that mortality was lower, and that a strong inverse correlation was found between mortality and early surfactant use. Being a retrospective study, there is the possibility of confounding variables, and so a double blind controlled study is needed to explore the timing of surfactant administration in the late preterm infant.

Variation in Use by NICU Types in the United States

Using the Vermont Oxford Network database of all NICU admissions, we assessed variation within predefined gestational age categories in the following proportions: admissions, initial NICU hospitalization days, high-acuity cases ≥34 weeks' gestation, and short-stay cases ≥34 weeks' gestation. High acuity was defined as follows: death, intubated assisted ventilation for ≥4 hours, early bacterial sepsis, major surgery requiring anesthesia, acute transport to another center, hypoxic-ischemic encephalopathy or a 5-minute Apgar score ≤3, or therapeutic hypothermia. Short stay was defined as an inborn infant staying 1 to 3 days with discharge from the hospital. From 2014 to 2016, 486 741 infants were hospitalized 9 657 508 days at 381 NICUs in the United States. The median proportions of admissions, initial hospitalized days, high-acuity cases, and short stays varied significantly by NICU types in almost all gestational age categories. Fifteen percent of the infants ≥34 weeks were high acuity, and 10% had short stays. There is substantial variation in use among NICUs. A campaign to focus neonatal care teams on using the NICU wisely that addresses the appropriate use of intensive care for newborn infants and accounts for local context and the needs of families is needed.

Effects of Gestational Age on Early Survivability in Neonates With Hypoplastic Left Heart Syndrome

Prematurity increases pre- and postoperative mortality in children with congenital heart disease. There are no large, multicentered, studies that have evaluated this relation specifically in neonates with hypoplastic left heart syndrome (HLHS). We sought to determine the impact of gestational age (GA) on survival to Stage 1 palliation surgery and hospital discharge in infants with HLHS. We reviewed data from 1,913 neonates with HLHS born at or transferred to a Vermont Oxford Network expanded member hospital in the United States from 2009 to 2014. Demographic, diagnostic, and surgical codes, and outcome data within the Vermont Oxford Network database were used to determine the effect of GA and birth weight on survival to Stage 1 palliation surgery and hospital discharge. Risk models were developed controlling for common confounders to determine the relative risk of GA on the observed outcomes. These data demonstrate that, when compared with 39-week infants, those born at earlier GA were less likely to survive until surgery; <34 weeks adjusted risk ratio (ARR) for survival: 0.47 (95% confidence interval 0.37 to 0.60), 34 to 35 weeks ARR 0.73 (0.62 to 0.87), and 36 to 37 weeks ARR 0.88 (0.83 to 0.94). Higher GA also positively correlated with survival to hospital discharge, although there was no difference in 34 to 35-week infants and 36 to 37-week infants. In conclusion, these data show that GA was an independent risk factor for survival to Stage 1 palliation surgery and survival to hospital discharge. However, there is no significant difference in survival to hospital discharge between infants born in 34 to 37 weeks gestation.

Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study

Objectives: The objective of this study is to determine the association between mode of delivery (vaginal delivery [VD] versus cesarean section [CS]) and the rate of significant intraventricular hemorrhage (sIVH) in preterm infants. Methods: A multicenter retrospective cohort study, based on data collected from the Vermont Oxford Network database. Infants born between 23 and 31+6 weeks of gestational age between 2001 and 2014 were identified. Exposure was the mode of birth (VD versus CS). Primary outcome was development of sIVH. Data were analyzed using univariate and multivariate statistical methods. Results: A total of 1575 infants were eligible. Nine hundred and two infants were born by CS and 673 by VD. Univariable analysis showed that infants born vaginally were more likely to have sIVH (p < .001), die before discharge (p < .001), have a composite poor outcome (death, sIVH or PVL), need oxygen therapy at 36-week corrected gestation (p = .010) and have a longer hospital stay (p = .006). After adjusting for available confounders, multivariable analysis persistently showed that infants between 23 and 27 weeks born by CS were less likely to develop sIVH [OR 1.61 (1.01–2.58), p = .049]. Conclusions: sIVH is less common in very preterm infants (23–27 weeks of gestation) delivered by CS. However, neurodevelopmental risks associated with survival at this early age, as well as increased maternal morbidities must also be considered.

Short-term outcomes of inborn v. outborn very-low-birth-weight neonates (

The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p&lt;0.0001) and antenatal steroids (64.2% v. 15.2%; p&lt;0.0001). Inborns required less ventilatory support (16.2% v. 57.9%; p&lt;0.0001) and surfactant administration than outborns (25.3% v. 65.1%; p&lt;0.0001), and developed less late infection (8.8% v. 23.4%; p&lt;0.0001), severe intraventricular haemorrhage (3.7% v. 13.9%; p&lt;0.0001) and chronic lung disease (5.3% v. 13.4%; p=0.003). The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227). The mortality rate was 18.4% for inborns and 33.3% for outborns (p&lt;0.0001). Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003). VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to excellent outcomes.

Screening Tool for Early Postnatal Prediction of Retinopathy of Prematurity in Preterm Newborns (STEP-ROP)

Background: Retinopathy of prematurity (ROP) is a disorder of the preterm newborn characterized by neurovascular disruption in the immature retina that may cause visual impairment and blindness. Objective: To develop a clinical screening tool for early postnatal prediction of ROP in preterm newborns based on risk information available within the first 48 h of postnatal life. Methods: Using data submitted to the Vermont Oxford Network (VON) between 1995 and 2015, we created logistic regression models based on infants born <28 completed weeks gestational age. We developed a model with 60% of the data and identified birth weight, gestational age, respiratory distress syndrome, non-Hispanic ethnicity, and multiple gestation as predictors of ROP. We tested the model in the remaining 40%, performed tenfold cross-validation, and tested the score in ELGAN study data. Results: Of the 1,052 newborns in the VON database, 627 recorded an ROP status. Forty percent had no ROP, 40% had mild ROP (stages 1 and 2), and 20% had severe ROP (stages 3-5). We created a weighted score to predict any ROP based on the multivariable regression model. A cutoff score of 5 had the best sensitivity (95%, 95% CI 93-97), while maintaining a strong positive predictive value (63%, 95% CI 57-68). When applied to the ELGAN data, sensitivity was lower (72%, 95% CI 69-75), but PPV was higher (80%, 95% CI 77-83). Conclusions: STEP-ROP is a promising screening tool. It is easy to calculate, does not rely on extensive postnatal data collection, and can be calculated early after birth. Early ROP screening may help physicians limit patient exposure to additional risk factors, and may be useful for risk stratification in clinical trials aimed at reducing ROP.

The Mortality of Extremely Premature Infants and the Impact on the Overall Neonatal Mortality Rate [20C

INTRODUCTION: Live births (LBs) in Ohio include any infant who had a heart rate, or took a breath or had any movement. In some countries infants less than 23 weeks are not counted as LBs. The study objective was to investigate the mortality in infants less than 500 grams (g) and to calculate their impact on the overall Neonatal Mortality Rate (NMR) over a 12-year period. METHODS: NMR data were extracted from the Good Samaritan Mortality Committee, CCHMC Perinatal Outreach Project and Vermont Oxford Network database from 1998–2009. RESULTS: Among 73,547 LBs were 699 deaths. The average NMR per 1,000 LBs was 11.4. The average adjusted NMR per 1,000 LB was 4.9. Overall, 349 LBs weighed less than 500 g and 336 died. The proportion of neonatal deaths less than 500 g, to the total NMR, was 48.6%. Infants' weight reported to the State included: 30–100 g (n=11), 101–200 g (n=40), and 201–300 g (n=63). Gestational age (GA) included: 15–17 weeks (n=35), 18–20 weeks (n=108), and 21–23 weeks (n=155). Causes of death included: GA less than or equal to 23 weeks (88.6%, n=298), lethal malformations (4.7%, n=16), RDS (8.6%, n=29), and sepsis (7.4%, n=25); 297 (88.3%) infants died in the delivery room. CONCLUSION: NMR from extreme prematurity was 96.2% and represented half of the overall NMR. Current LB definition and a reporting system of a 30 gram infant as a neonatal death has placed Ohio and the USA at a significant disadvantage compared with other countries with different reporting systems.

Hospital transfers and patterns of mortality in very low birth weight neonates with surgical necrotizing enterocolitis

PurposeThe objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality. MethodsMortality among 4328 VLBW neonates with surgical NEC born 2009–2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants). ResultsMortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)). ConclusionTransfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted.

Improvement in Rates of Preterm Infant Hypothermia by the Implementation of a Best Practice Bundle

Objective To decrease the number of preterm infants with hypothermia on admission to the NICU by improving delivery room management. Design A best practice bundle was developed for preterm infants. This included the use of heated mattress pads for all infants 36‐weeks gestational age or less and polyethylene bags for infants 28‐weeks gestational age or fewer. Additionally, to prevent convective and conductive heat loss, preterm infants were not weighed in the delivery room, and operating room temperatures were set to 25 degrees C. Sample Data were collected for 300 preterm neonates admitted to the NICU between January 2013 and June 2014. Methods Using plan‐do‐check‐act (PDCA) methodology, an interprofessional team reviewed the literature, developed and implemented an evidence‐based protocol, and evaluated outcomes. Normal admission temperature was defined as 36.5 degrees C or greater within one hour of birth. Implementation Strategies All nursing and physician staff who attended births were educated on the significance of infant hypothermia and the bundle components. Following implementation of the bundle, outcomes were tracked and disseminated on a monthly basis. Outliers were analyzed and debriefs with the nursing and physician staff were conducted. Results The retrospective baseline data included 45 infants: 10 (22%) had admission temperatures of 36.5 degrees C or greater. Postimplementation, there was a steady improvement in admission temperatures. By the third quarter of 2014, 68% of infants in had admission temperatures of 36.5 degrees C or greater. For the low‐birth‐weight infants tracked in the Vermont Oxford Network (VON) database, for the 3 years prior to the bundle implementation, we performed at 3.8%, 3.10%, and 14.3%. The year postimplementation, of 12 VLBW neonates, 75% met the standard for temperature on admission to NICU. Conclusion/Implications for Nursing Practice Successful implementation of this project required a commitment from the obstetric and neonatal teams. Although it is clearly our responsibility to take admission temperatures and monitor various physiologic parameters in individual neonates, it is equally incumbent on the team to analyze aggregate data indicators to monitor overall performance. Data dissemination has been a crucial factor in maintaining awareness of this problem and providing the impetus for continued use of the bundle elements. In addition, conducting a case by case analysis of outliers is essential for ensuring that any gaps in performance are recognized and rectified by providing feedback to individual providers. To decrease the number of preterm infants with hypothermia on admission to the NICU by improving delivery room management. A best practice bundle was developed for preterm infants. This included the use of heated mattress pads for all infants 36‐weeks gestational age or less and polyethylene bags for infants 28‐weeks gestational age or fewer. Additionally, to prevent convective and conductive heat loss, preterm infants were not weighed in the delivery room, and operating room temperatures were set to 25 degrees C. Data were collected for 300 preterm neonates admitted to the NICU between January 2013 and June 2014. Using plan‐do‐check‐act (PDCA) methodology, an interprofessional team reviewed the literature, developed and implemented an evidence‐based protocol, and evaluated outcomes. Normal admission temperature was defined as 36.5 degrees C or greater within one hour of birth. All nursing and physician staff who attended births were educated on the significance of infant hypothermia and the bundle components. Following implementation of the bundle, outcomes were tracked and disseminated on a monthly basis. Outliers were analyzed and debriefs with the nursing and physician staff were conducted. The retrospective baseline data included 45 infants: 10 (22%) had admission temperatures of 36.5 degrees C or greater. Postimplementation, there was a steady improvement in admission temperatures. By the third quarter of 2014, 68% of infants in had admission temperatures of 36.5 degrees C or greater. For the low‐birth‐weight infants tracked in the Vermont Oxford Network (VON) database, for the 3 years prior to the bundle implementation, we performed at 3.8%, 3.10%, and 14.3%. The year postimplementation, of 12 VLBW neonates, 75% met the standard for temperature on admission to NICU. Successful implementation of this project required a commitment from the obstetric and neonatal teams. Although it is clearly our responsibility to take admission temperatures and monitor various physiologic parameters in individual neonates, it is equally incumbent on the team to analyze aggregate data indicators to monitor overall performance. Data dissemination has been a crucial factor in maintaining awareness of this problem and providing the impetus for continued use of the bundle elements. In addition, conducting a case by case analysis of outliers is essential for ensuring that any gaps in performance are recognized and rectified by providing feedback to individual providers.

A Predictive Model for SIVH risk in Preterm Infants and Targeted Indomethacin Therapy for Prevention

Prophylactic indomethacin may decrease Severe Intraventricular Hemorrhage (SIVH). Our goal was to develop a predictive model for SIVH using parameters available by six hours of age. De-identified data for preterm infants born ≤ 34 weeks gestational age was abstracted from Vermont Oxford Network database. Using clinical variables available by 6 hrs of age the model was developed, and validated. Statistical methods were used to evaluate the ability of the model to discriminate infants with and without SIVH and, to compare observed and predicted risk. The model achieved excellent discrimination as indicated by ROC curve of 0·85. A good agreement was noted between observed and predicted risk (HLtest: p = 0·22). Application of the model to patients receiving indomethacin suggests a benefit at the highest risk levels. We have developed a valid predictive model for predicting SIVH as well as shown that exposure to indomethacin decreases the incidence of SIVH overall.

1282 An Analysis of Retinopathy of Prematurity Requiring Treatment Over 5Years Period in Our Neonatal Unit

BackgroundProliferative retinopathy occurs primarily in premature LBW infants as a result of incomplete vasculogensis of the retina at the time of birth. It can be mild, self limiting with no...

“Early” versus “late” 23-week infant outcomes

To determine whether survival is different in "early" (23(0/7)-23(3/7) weeks) vs "late" (23(4/7)-23(6/7) weeks) infants. Records of 126 consecutive liveborn infants delivered at 23(0/7) to 23(6/7) weeks' gestation from 2001-2010 were examined using the Vermont Oxford Network database. Infants born at 23 0/7 to 23 3/7 weeks were grouped into "early" and those at 23 4/7 to 23 6/7 weeks were "late." Clinical characteristics were compared between groups and multivariate analyses were used to predict survival. Seventy-two infants were early and 54 were late. Survival was 25% vs 56%, respectively (P < .001). The early group was less likely to receive steroids (43% vs 65%; P = .016) and had a lower mean birthweight (547 g vs 596 g; P < .001). No difference in other factors was seen between groups. No change in survival was observed during the study period in either group. Late 23-week infants have improved survival compared with early infants. Delaying delivery as little as 24-96 hours may improve survival for 23-week infants.

Improvements in birth weight-specific neonatal mortality rates in the state of Qatar between 2003 &amp; 2010 and a comparative analysis with the Vermont Oxford Network database report of 2007: A pearl study review

Objective:The study aimed to develop a national reference on birth weight-specific neonatal survival in the State of Qatar to facilitate parental counseling.Study Design:This was a retrospective, analytic, and comparative study.Materials and Methods:The birth weight-specific neonatal mortality data for the years 2003 and 2010, collected from the admission and discharge registers of the neonatal intensive care unit, were stratified using the stratifications given in Vermont Oxford Network (VON) 2007 annual report. Category-wise birth weight-specific mortality and relative risk (RR) of death were compared between Qatar data (2003 and 2010) and VON 2007 report.Results:Qatar's neonatal mortality rate (NMR) dropped from 5 of 1000 in 2003 to 4.4 of 1000 in 2010 (P=0.443) which was significant for birth weight categories 501–750 g and 751–1000 g (P=0.026 and P=0.05, respectively). Qatar's NMR in 2010 was significantly lower than VON's NMR during 2007 (P<0.001) though VON's NMR was significantly lower among birth weight categories 751–1000 g and 1001–1500 g (P=0.001 and P=0.003, respectively). The RR of mortality decreased with increasing birth weight. The decline was very sharp for birth weight categories between 500 and 1500g. The RR was 25 times higher in babies with birth weight less than 750 g as compared to babies with birth weight ≥ 2550 g, both in Qatar and VON data. For birth weight categories 751–1000 g and 1001–1500 g, the RR was twice in Qatar as compared to the VON report (16.8 versus 7.8, and 5.5 versus 2.7, respectively).Conclusions:Qatar's current overall and birth weight-specific NMRs are comparable with the VON report except in birth weight categories 751–1000 g and 1001–1500 g which were higher in Qatar. This needs further in-depth qualitative analysis.

Interleukin-6 Polymorphism is Associated with Chorioamnionitis and Neonatal Infections in Preterm Infants

To evaluate whether genotypes of interleukin (IL)-6 gene promoter positions -174 and -572 are associated with histologic chorioamnionitis and neonatal inflammatory disease in preterm infants. DNA from very low birth weight or very preterm infants (n = 107) was genotyped for IL-6-174 and -572 polymorphisms (GG/GC/CC). The placentas were analyzed for histological inflammatory findings. Data on neonatal inflammatory diseases, including chronic lung disease (CLD), necrotizing enterocolitis (NEC), and septicemia, were collected using the definitions of the Vermont Oxford Network database. In univariate analyses, the IL-6-174 GG genotype was associated with a higher incidence of histologic chorioamnionitis. In multivariate analyses, the -174 GG and -572 GC genotypes were correlated with histologic chorioamnionitis (P = .039 and .009, respectively). Gestational age was not associated with genotype polymorphisms. IL-6-174 genotypes were not associated with CLD and/or NEC, but the CC genotype was correlated with septicemia in both univariate and multivariate analyses (P = .027). IL-6-572 genotypes were not associated with neonatal inflammatory disease. The IL-6-174 GG and -572 GC genotypes were associated with a higher incidence of histologic chorioamnionitis, and the IL-6-174 CC genotype was associated with septicemia in preterm infants. These findings suggest that the genetic composition of the IL-6 promoter area plays a significant role in the pathogenesis of chorioamnionitis and neonatal infections.

Fetal infants: the fate of 4172 infants with birth weights of 401 to 500 grams--the Vermont Oxford Network experience (1996-2000).

Improvement in the survival of extremely low birth weight infants requires that we evaluate the limits of our care and assess the impact of treatment on a population of infants who previously rarely survived. A review was conducted of demographic and clinical data of infants who had birth weight 401 to 500 g and were entered in the Vermont Oxford Network Database between 1996 and 2000. A total of 4172 infants who weighed 401-500 g (mean gestational age: 23.3 +/- 2.1 weeks) were born at 346 participating centers. Overall, 17% survived until discharge. A total of 2186 (52%) died in the delivery room (DR), and 1986 (48%) were admitted to a neonatal intensive care unit (NICU). Compared with infants who died in the DR, infants who survived the DR and were admitted to the NICU were more likely to be female (58% vs 49%), to be small for gestational age (56% vs 11%), to have received prenatal steroids (61% vs 12%), and to have been delivered by cesarean section (55% vs 5%). Thirty-six percent of NICU admissions survived to discharge. Mean gestational age of the 690 NICU survivors was 25.3 +/- 2.0 weeks. These survivors experienced significant morbidity in the NICU. An appreciable number of these marginally viable fetal infants survive. They experienced a high rate of serious morbidities while in the NICU. There is very little information about long-term outcomes, as the medical and developmental status of few of these infants has been followed carefully. Parents should be made aware of the high incidence of serious problems, and concerted efforts should be made to follow the status of these infants.

The Vermont Oxford Network

After completing this article, readers should be able to: 1. Describe the topics of study of the Neonatal Intensive Care Quality Improvement Collaboratives. 2. List the four key habits of clinical improvement. “The nation’s health care system lacks… the capabilities to ensure that services are safe, effective, patient-centered, timely, efficient and equitable… Between the health care we have and the care we could have, lies not just a gap but a chasm.” IOM 2001 (1) “More people die in a given year as a result of medical errors than from motor vehicle accidents, breast cancer, or AIDS.” IOM 2000 (2) In 2000 and 2001, the Institute of Medicine (IOM) of the National Academy of Sciences issued two landmark reports that presented a clear and compelling challenge to all health care professionals. (1)(2) We must improve the quality and safety of the medical care for the patients and families that we serve. In this article, we describe the Vermont Oxford Network (VON) and the quality improvement (QI) activities it has undertaken to meet this challenge. The VON is a not-for-profit organization whose mission is to improve the quality and safety of medical care for newborns and their families through a coordinated program of research, education, and quality improvement. (3)(4) VON currently has more than 440 member neonatal intensive care units (NICUs) from North America and around the world. Members participate in a range of Network activities, including randomized controlled trials, outcomes research, and a variety of QI projects. The focus of this article is QI. Descriptions and references for other VON activities are available on the VON Internet site (http://www.vtoxford.org). In support of its mission, VON maintains a database that includes information about the treatment and outcomes for high-risk infants receiving neonatal intensive care. Importantly, all …