Quality Indicators but Not Admission Volumes of Neonatal Intensive Care Units Are Effective in Reducing Mortality Rates of Preterm Infants

Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns

Background

Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015. 

Methods

Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004–2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates.

Results

Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected.

Conclusions

Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13629-4.

Chinese Neonatal Network: a national protocol for collaborative research and quality improvement in neonatal care

INTRODUCTION

The objective of the Chinese Neonatal Network (CHNN) is to provide a platform for collaborative research, outcomes evaluation and quality improvement for preterm infants with gestational age less than 32 weeks in China. The CHNN is the first national neonatal network and has the largest geographically representative cohort from neonatal intensive care units (NICUs) in China.

METHODS AND ANALYSIS

Individual-level data from participating NICUs will be collected using a unique database developed by the CHNN on an ongoing basis from January 2019. Data will be prospectively collected from all infants <32 weeks gestation or <1500 g birth weight at 58 participating NICUs. Infant outcomes and inter-institutional variations in outcomes will be examined and used to inform quality improvement measures aimed at improving outcomes. Information about NICU environmental and human resource factors and processes of neonatal care will also be collected and analysed for association with outcomes. Clinical studies, including randomised controlled trials will be conducted using the CHNN data platform.

ETHICS AND DISSEMINATION

This study was approved by the ethics review board of Children's Hospital of Fudan University, which was recognised by all participating hospitals. Waiver of consent were granted at all sites. Only non-identifiable patient level data will be transmitted and only aggregate data will be reported in CHNN reports and publications.

[Quality of Care for Very Low Birth Weight Infants in Germany - Evaluation of Publicly Available Data from 2014 to 2018]

Hintergrund Seit 2014 werden Ergebnisdaten der Versorgung sehr kleiner Frühgeborener (FG) in Deutschland zentral erfasst und sind unter www.perinatalzentren.org abrufbar. Mit den online verfügbaren Daten soll der Zusammenhang zwischen Fallzahl und Ergebnisqualität untersucht werden.

Methoden Bei der Ergebnisveröffentlichung für den 5-Jahreszeitraum 2014–2018 werden die Fallzahl pro Perinatalzentrum und Überleben bzw. Überleben ohne schwere Erkrankungen in Relation zum Bundesdurchschnitt für FG<1500 g Geburtsgewicht ausgewiesen. Neben der Fallzahl wird auch eine nach Risikofaktoren adjustierte Fallzahl ausgewiesen. Mittels Regression wurde der Zusammenhang zwischen Fallzahl, adjustierter Fallzahl und Überlebenswahrscheinlichkeit untersucht.

Ergebnisse Von den 212 Perinatalzentren waren 163 (77%) als Level 1 und 49 (23%) als Level 2 Zentren gelistet und versorgten 9300 (94%; Median 51; Min 13 bis Max 186) bzw. 538 (6%; 9; 4–28) FG<1500 g pro Jahr. Für die Fallzahl ließ sich keine signifikante Korrelation mit der Überlebenswahrscheinlichkeit nachweisen. Die adjustierte Fallzahl zeigte einen schwachen linearen Zusammenhang mit dem Überleben ohne schwere Erkrankungen (p=0,02; R2=0,03). Bei nicht-parametrischer Regression stellten sich signifikante Effekte ab einer adjustierten Fallzahl von mehr als 170 (Überleben) bzw. 100 (Überleben ohne schwere Erkrankungen) FG pro Jahr und Zentrum ein. Im Bereich darunter erklärt die Fallzahl keinen Anteil der Streuung.

Schlussfolgerung Es findet sich nur ein schwacher linearer und nichtlinearer Zusammenhang zwischen adjustierter Fallzahl und relativer Überlebenswahrscheinlichkeit, der maßgeblich durch sehr große Zentren getrieben ist.

Zum Beitrag „Wie hoch ist die optimale Mindestmenge für die Behandlung Frühgeborener mit einem Geburtsgewicht unter 1250 g in Deutschland?“

Es war Ziel der Autoren mit ihrer Arbeit zu klären, ob ein Schwellenwert identifiziert werden kann, für den ein optimaler Behandlungseffekt nach Einführung einer Mindestmenge zu erwarten ist 1. Das ist ein wichtiges Ziel.

[What is the Optimal Minimum Provider Volume in the Provision of Care for Preterm Infants with a Birth Weight below 1250 g in Germany?]

INTRODUCTION

Numerous studies have investigated volume-outcome relationships in the treatment of very low birth weight infants. However, studies addressing the identification of optimal thresholds when introducing minimum provider volumes for treatment of these infants do not exist.

METHODS

Publicly available data (www.perinatalzentren.org) of more than 56,000 infants weighing less than 1250 g at birth (NB<1250) and treated in level-1 perinatal centers (highest level in Germany) between 2010 and 2018 was used for statistical analysis. Potentially avoidable deaths after the introduction of minimum provider volumes were calculated by deducting observed deaths from estimated deaths based on logistic regression models for every existing empirical provider volume. Various smoothing functions were used to ascertain optimal thresholds for minimum provider volumes.

RESULTS

Independent of the observation period or smoothing technique, the highest number of potentially avoidable deaths was observed for minimum provider volumes of 50-60 NB<1250 per year. Introducing a minimum provider volume of 50 without a transition period would reduce the number of level-1 perinatal centers to a quarter of the current number in Germany. Approximately 60% of NB<1250 would have to be reallocated.

CONCLUSION

Analyses of resulting geographical distances are needed in the preparation of minimum provider volumes for treatment of NB<1250 in Germany. Such analyses should include perinatal centers expected to reach minimum provider volumes after subsequent reallocation in the future.

More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland)

• Quality and outcome of pediatric resuscitation often does not achieve recommended goals. • Quality improvement initiatives with the aim of better survival rates and decreased morbidity of resuscitated children are urgently needed. • These initiatives should include an action framework for a comprehensive, fundamental, and interprofessional reorientation of clinical and organizational structures concerning resuscitation and post-resuscitation care of children. • The authors of this DACH position statement suggest the implementation of 10 evidence-based actions (for out-of-hospital and in-house cardiac arrests) that should improve survival rates and decrease morbidity of resuscitated children with better neurological outcome and quality of life.

From structural modalities in perinatal medicine to the frequency of preterm birth

Preterm birth is a global health problem that affects 11% of all live births: it remains a significant cause of death and an important cause of long-term loss of human potential among survivors all around the world. In the last decade, many developed countries have seen an increase in the rate of infants born preterm. Various theoretical and practical concepts have been discussed that aim to optimize the perinatal care of preterm infants and their mothers. These include the definition of hospitals with different levels of care, the regionalization of care, the creation of large care units with high case numbers, and a high level of expertise. This review article focuses on the connection between health care structures and different aspects of preterm birth. Furthermore, this review article highlights the fact that preterm birth is a heterogeneous syndrome with many underlying pathologies and that the causality for a large number of cases remains unexplained. There is still a significant knowledge gap concerning the actual drivers of spontaneous preterm birth, and future research particularly in parturition immunology as well as genetics of prematurity will be essential to identify new targets for therapy.

Quality Improvement in Perinatal Medicine and Translation of Preterm Birth Research Findings into Clinical Care

Billions of dollars are spent yearly in perinatal medicine on studies designed to improve outcomes for mothers and their neonates. However, implementing research findings is challenging and imperfect. Strategies for implementation must be multifaceted and comprehensive. These implementation challenges extend to, and are often greater in, translational and basic science research. The purpose of this review is to discuss current challenges in the provision of quality perinatal and neonatal medical care, particularly those related to preterm birth, and provide examples of prematurity-related perinatal quality collaborative initiatives. Finally, the authors review considerations in implementing both clinical and translational/basic science prematurity research.