Shoo K Lee1, Prakesh S Shah2, Nalini Singhal1, Khalid Aziz1, Anne Synnes1, Douglas McMillan1, Mary M Seshia1. 1. Department of Paediatrics (Lee, Shah), University of Toronto, Toronto, Ont.; Department of Pediatrics (Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Aziz), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Synnes), University of British Columbia, Vancouver, BC; Department of Pediatrics (McMillan), Dalhousie University, Halifax, NS; Department of Pediatrics (Seshia), University of Manitoba, Winnipeg, Man. 2. Department of Paediatrics (Lee, Shah), University of Toronto, Toronto, Ont.; Department of Pediatrics (Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Aziz), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Synnes), University of British Columbia, Vancouver, BC; Department of Pediatrics (McMillan), Dalhousie University, Halifax, NS; Department of Pediatrics (Seshia), University of Manitoba, Winnipeg, Man. pshah@mtsinai.on.ca.
Abstract
BACKGROUND: We previously demonstrated improvement in bronchopulmonary dysplasia and nosocomial infection among preterm infants at 12 neonatal units using the Evidence-based Practice for Improving Quality (EPIQ). In the current study, we assessed the association of Canada-wide implementation of EPIQ with mortality and morbidity among preterm infants less than 29 weeks gestational age. METHODS: This prospective cohort study included 6026 infants admitted to 25 Canadian units between 2008 and 2012 (baseline year, n = 1422; year 1, n = 1611; year 2, n = 1508; year 3, n = 1485). Following a 1-year baseline period and 6 months of training and planning, EPIQ was implemented over 3 years. Our primary outcome was a composite of neonatal mortality and any of bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity, necrotizing enterocolitis and nosocomial infection. We compared outcomes for baseline and year 3 using multivariable analyses. RESULTS: In adjusted analyses comparing baseline with year 3, the composite outcome (70% v. 65%; adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.51 to 0.79), severe retinopathy (17% v. 13%; OR 0.60, 95% CI 0.45 to 0.79), necrotizing enterocolitis (10% v. 8%; OR 0.73, 95% CI 0.52 to 0.98) and nosocomial infections (32% v. 24%; OR 0.63, 95% CI 0.48 to 0.82) were significantly reduced. The composite outcome was lower among infants born at 26 to 28 weeks gestation (62% v. 52%; OR 0.62, 95% CI 0.49 to 0.78) but not among infants born at less than 26 weeks gestational age (90% v. 88%; OR 0.73, 95% CI 0.44 to 1.20). INTERPRETATION: EPIQ methodology was generalizable within Canada and was associated with significantly lower likelihood of the composite outcome, severe retinopathy, necrotizing enterocolitis and nosocomial infections. Infants born at 26 to 28 weeks gestational age benefited the most.
BACKGROUND: We previously demonstrated improvement in bronchopulmonary dysplasia and nosocomial infection among preterm infants at 12 neonatal units using the Evidence-based Practice for Improving Quality (EPIQ). In the current study, we assessed the association of Canada-wide implementation of EPIQ with mortality and morbidity among preterm infants less than 29 weeks gestational age. METHODS: This prospective cohort study included 6026 infants admitted to 25 Canadian units between 2008 and 2012 (baseline year, n = 1422; year 1, n = 1611; year 2, n = 1508; year 3, n = 1485). Following a 1-year baseline period and 6 months of training and planning, EPIQ was implemented over 3 years. Our primary outcome was a composite of neonatal mortality and any of bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity, necrotizing enterocolitis and nosocomial infection. We compared outcomes for baseline and year 3 using multivariable analyses. RESULTS: In adjusted analyses comparing baseline with year 3, the composite outcome (70% v. 65%; adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.51 to 0.79), severe retinopathy (17% v. 13%; OR 0.60, 95% CI 0.45 to 0.79), necrotizing enterocolitis (10% v. 8%; OR 0.73, 95% CI 0.52 to 0.98) and nosocomial infections (32% v. 24%; OR 0.63, 95% CI 0.48 to 0.82) were significantly reduced. The composite outcome was lower among infants born at 26 to 28 weeks gestation (62% v. 52%; OR 0.62, 95% CI 0.49 to 0.78) but not among infants born at less than 26 weeks gestational age (90% v. 88%; OR 0.73, 95% CI 0.44 to 1.20). INTERPRETATION: EPIQ methodology was generalizable within Canada and was associated with significantly lower likelihood of the composite outcome, severe retinopathy, necrotizing enterocolitis and nosocomial infections. Infants born at 26 to 28 weeks gestational age benefited the most.
Authors: J M Grimshaw; R E Thomas; G MacLennan; C Fraser; C R Ramsay; L Vale; P Whitty; M P Eccles; L Matowe; L Shirran; M Wensing; R Dijkstra; C Donaldson Journal: Health Technol Assess Date: 2004-02 Impact factor: 4.014
Authors: Barbara Kuzma-O'Reilly; Maria L Duenas; Coleen Greecher; Lois Kimberlin; Dennis Mujsce; Debra Miller; Donna Jean Walker Journal: Pediatrics Date: 2003-04 Impact factor: 7.124
Authors: Jeffrey D Horbar; Joseph H Carpenter; Jeffrey Buzas; Roger F Soll; Gautham Suresh; Michael B Bracken; Laura C Leviton; Paul E Plsek; John C Sinclair Journal: BMJ Date: 2004-10-30
Authors: Prakesh S Shah; Kei Lui; Brian Reichman; Mikael Norman; Satoshi Kusuda; Liisa Lehtonen; Mark Adams; Maximo Vento; Brian A Darlow; Neena Modi; Franca Rusconi; Stellan Håkansson; Laura San Feliciano; Kjell K Helenius; Dirk Bassler; Shinya Hirano; Shoo K Lee Journal: Transl Pediatr Date: 2019-07
Authors: Prakesh S Shah; Sarah D McDonald; Jon Barrett; Anne Synnes; Kate Robson; Jonathan Foster; Jean-Charles Pasquier; K S Joseph; Bruno Piedboeuf; Thierry Lacaze-Masmonteil; Karel O'Brien; Sandesh Shivananda; Nils Chaillet; Petros Pechlivanoglou Journal: CMAJ Open Date: 2018-01-18
Authors: Kamini Raghuram; Michael Dunn; Krista Jangaard; Maureen Reilly; Elizabeth Asztalos; Edmond Kelly; Michael Vincer; Vibhuti Shah Journal: BMC Pediatr Date: 2018-05-07 Impact factor: 2.125
Authors: Joseph Y Ting; Ashley Roberts; Peter Tilley; Joan L Robinson; Michael S Dunn; Vanessa Paquette; Kyong-Soon Lee; Vibhuti Shah; Eugene Yoon; Lindsay L Richter; Abhay Lodha; Sandesh Shivananda; Nisha Thampi; Julie Autmizguine; Prakesh S Shah Journal: BMJ Open Date: 2020-12-10 Impact factor: 2.692