Gabriel Altit1, Sahar Saeed2, Marc Beltempo3, Martine Claveau4, Anie Lapointe5, Olga Basso6. 1. Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University. Electronic address: Gabriel.altit@mail.mcgill.ca. 2. Epidemiology / Post-Doctoral Fellow; Washington University (St. Louis). 3. Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University. 4. Neonatology - McGill University Health Centre - Montreal Children's Hospital; Department of Pediatrics - McGill University; Ingram School of Nursing, McGill University. 5. Neonatology -CHU Sainte-Justine - Université de Montréal. 6. Department of Obstetrics and Gynecology, McGill University Health Centre; Department of Epidemiology, Biostatistics and Occupational Health, McGill University.
Abstract
OBJECTIVE: To evaluate the change in the proportion of deaths/bronchopulmonary dysplasia (BPD) among premature infants (<26 and 26-29 weeks) following a policy change to a strict non-intervention approach, compared with standard treatment. STUDY DESIGN: We examined 1249 infants (341 <26 weeks) at two comparable sites. Site #1 (control) continued medical treatment/ligation, and site #2 (exposed) changed to a non-intervention policy in late 2013. Using the difference-in-differences approach, which accounts for time-invariant differences between sites and secular trends, we assessed changes in death or BPD separately among 26-29 weeks and <26 weeks in two epochs (epoch 1: 2011-2013; epoch 2: 2014-2017). RESULTS: Baseline characteristics were similar across sites and epochs. Medical treatment/ligation use remained stable at site #1 but declined progressively to 0% at site #2, indicating adherence to policy. We saw no difference in death/BPD among babies born at 26-29 weeks (12%, 95%CI: -1 to 24%). However, incidence of death/BPD increased by 31% among <26 weeks [95% CI: 10 to 51%] in site #2, whereas there was no change in outcomes in site #1. The Score for Neonatal Acute Physiology-Version II, used as a control outcome, did not change in either site, suggesting that our findings were not due to changes in patients' severity. CONCLUSION: Adherence to a strict conservative policy did not impact death or BPD among ≥26 weeks but was associated with a significant rise in infants born <26 weeks.
OBJECTIVE: To evaluate the change in the proportion of deaths/bronchopulmonary dysplasia (BPD) among premature infants (<26 and 26-29 weeks) following a policy change to a strict non-intervention approach, compared with standard treatment. STUDY DESIGN: We examined 1249 infants (341 <26 weeks) at two comparable sites. Site #1 (control) continued medical treatment/ligation, and site #2 (exposed) changed to a non-intervention policy in late 2013. Using the difference-in-differences approach, which accounts for time-invariant differences between sites and secular trends, we assessed changes in death or BPD separately among 26-29 weeks and <26 weeks in two epochs (epoch 1: 2011-2013; epoch 2: 2014-2017). RESULTS: Baseline characteristics were similar across sites and epochs. Medical treatment/ligation use remained stable at site #1 but declined progressively to 0% at site #2, indicating adherence to policy. We saw no difference in death/BPD among babies born at 26-29 weeks (12%, 95%CI: -1 to 24%). However, incidence of death/BPD increased by 31% among <26 weeks [95% CI: 10 to 51%] in site #2, whereas there was no change in outcomes in site #1. The Score for Neonatal Acute Physiology-Version II, used as a control outcome, did not change in either site, suggesting that our findings were not due to changes in patients' severity. CONCLUSION: Adherence to a strict conservative policy did not impact death or BPD among ≥26 weeks but was associated with a significant rise in infants born <26 weeks.
Authors: Carl H Backes; Kevin D Hill; Elaine L Shelton; Jonathan L Slaughter; Tamorah R Lewis; Dany E Weisz; May Ling Mah; Shazia Bhombal; Charles V Smith; Patrick J McNamara; William E Benitz; Vidu Garg Journal: J Am Heart Assoc Date: 2022-09-03 Impact factor: 6.106