Comparing Like with Like When Reporting Neurodevelopmental Outcomes after Preterm Birth

DeMauro, Sara B.; Schmidt, Barbara

doi:10.1016/j.jpeds.2018.01.042

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Elusive quality improvement truths that are scalable lie somewhere between an uncritical acceptance of linear, factory‐based methodology and the ressentiment of complex network science in general . In the meantime, other than optimising maternal health and lessening the burden of premature birth, the surest strategy to improve long‐term neurodevelopmental health of ELGANs is to reduce NICU morbidities .…”

Section: Resultsmentioning

confidence: 99%

Sustained quality improvement collaboration and composite morbidity reduction in extremely low gestational age newborns

Kaempf¹,

Morris²,

Austin

et al. 2019

Acta Paediatrica

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Aim: Continuous quality improvement has failed to consistently reduce morbidities in extremely low gestational age newborns 23-27 weeks. 10 Vermont Oxford Network NICUs describe a novel, sustained collaboration for progress.Methods: We emphasised a) commitment to inter-NICU trust with face-to-face meetings, site visits, teleconferences, scrutiny of quality improvement methodology, b) transparent process and outcomes sharing, c) evidence-based formulation of an orchestrated testing matrix to select potentially better practices, d) family integration, e) benchmarking with a composite mortality-morbidity score (Benefit Metric).

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Section: Resultsmentioning

confidence: 99%

Sustained quality improvement collaboration and composite morbidity reduction in extremely low gestational age newborns

Kaempf¹,

Morris²,

Austin

et al. 2019

Acta Paediatrica

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“…Published definitions vary widely across studies [34]. Small variations in the definition of NDI can have a substantial influence on its rate in a population and on its association with specific variables [35,36]. Despite this, studies of NDI in children born extremely preterm are used as the basis for recommendations to make treatment decisions, including whether to direct care toward survival or palliation [1,24], and are frequently used as a component of the primary outcome of major clinical trials [2].…”

Section: Discussionmentioning

confidence: 99%

The relationship of neurodevelopmental impairment to concurrent early childhood outcomes of extremely preterm infants

Rysavy,

Colaizy,

Bann

et al. 2021

J Perinatol

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Objective Determine how neurodevelopmental impairment (NDI) relates to concurrent outcomes for children born extremely preterm. Study design Retrospective cohort study children born 22 0/7-26 6/7 weeks' gestation at NICHD Neonatal Research Network hospitals. Outcomes were ascertained at 18-22 months' corrected age.Result Of 6562 children, 2618 (40%) died and 441 (7%) had no follow-up. Among the remaining 3483 children, 825 (24%), 1576 (45%), 657 (19%), and 425 (12%) had no, potential/mild, moderate, and severe NDI, respectively. Rehospitalization, respiratory medications, surgery, and medical support services were associated with greater NDI severity but affected >10% of children without NDI. Rehospitalization occurred in 40% of children with no NDI (mean (SD): 1.7 (1.3) episodes). Conclusion Medical, functional, and social outcomes at 18-22 months' corrected age were associated with NDI; however, many children without NDI were affected. These data should contribute to counseling families and the design of studies for childhood outcomes beyond NDI.

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“…It is possible that changes over time occurred in certain strata but were obscured by averaging. A standardised definition of the population eligible for inclusion would allow better comparison of outcomes 42…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the lack of improvement in NDI rates is likely underestimated because we could not evaluate other important neurological outcomes. These include academic achievement, behavioural problems, autism spectrum disorder and other significant psychiatric conditions prevalent in extremely premature infants who are evaluated at school age 41–46. There is concerning evidence that NDI and related neuropsychiatric disabilities worsen over time 47–49.…”

Section: Discussionmentioning

confidence: 99%

Change in neurodevelopmental outcomes for extremely premature infants over time: a systematic review and meta-analysis

Kaempf

Guillén

Litt

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveSurvival rates of extremely premature infants are rising, but changes in neurodevelopmental impairment (NDI) rates are unclear. Our objective was to perform a systematic review of intrainstitutional variability of NDI over time.DesignSystematic review and meta-analysis.Data sourcesOvid MEDLINE, Embase, PubMed, Cochrane Library and Google Scholar.Study selectionStudy eligibility: (1) at least two discrete cohorts of infants born <27 weeks’ gestation or <1000 g birth weight, (2) one cohort born after 1990 and at least one subsequent cohort of similar gestational age, (3) all cohorts cared for within the same Neonatal Intensive Care Unit(s) (NICU) and (4) neurodevelopmental outcomes at 18–36 months corrected age.Main outcomeChange in NDI rates. Quality, validity and bias were assessed using Grading of Recommendations, Assessment, Development, and Evaluation and Quality in Prognosis Studies guidelines.ResultsOf 203 publications, 15 were eligible, including 13 229 infants. At the first time point, average NDI rate across study groups weighted by sample size was 41.0% (95% CI 34.0% to 48.0%). The average change in NDI between time points was −3.3% (95% CI −8·8% to 2.2%). For each added week of gestation at birth, the rate of NDI declined by 9.7% (95% CI 6.2% to 13.3%). Most studies exhibited moderate–severe bias in at least one domain, especially attrition rates.ConclusionsWhen comparing discrete same-centre cohorts over time, there was no significant change in NDI rates in infants born <27 weeks’ gestation or <1000 g. Higher survival rates unaccompanied by improvement in neurodevelopment highlight urgency for renewed focus on the causes of NDI and evidence-based strategies to reduce brain injury.

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Comparing Like with Like When Reporting Neurodevelopmental Outcomes after Preterm Birth

Cited by 4 publications

References 16 publications

Sustained quality improvement collaboration and composite morbidity reduction in extremely low gestational age newborns

Sustained quality improvement collaboration and composite morbidity reduction in extremely low gestational age newborns

The relationship of neurodevelopmental impairment to concurrent early childhood outcomes of extremely preterm infants

Change in neurodevelopmental outcomes for extremely premature infants over time: a systematic review and meta-analysis

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