Objective To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. Study design We included 58 004 infants born weighing <1500 g at 240–316 weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. Results Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. Conclusions We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
Bibliographical noteFunding Information:
Funding for iNeo of Neonates has been provided by a Canadian Institutes of Health Research (FRN87518) Chair in Reproductive and Child Health Services and Policy Research (to P.S.). Additional funding is available at www.jpeds.com (Appendix 2). The authors declare no conflicts of interest.
The Canadian Neonatal Network is funded by the Canadian Institutes of Health Research and individual participating centers. The Australian and New Zealand Neonatal Network is funded predominantly by membership contributions from participating centers. The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. SEN1500 is supported by funds from the Spanish Neonatal Society. The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs) and the body of regional health care providers (County Councils). SwissNeoNet is partially funded by participating units in the form of membership fees. The UKNC receives no core funding.
We thank Ruth Warre, PhD, and Lisa Martin, PhD (Maternal-Infant Care Research Centre, supported by the Canadian Institutes of Health Research and Mount Sinai Hospital, Toronto, Ontario, Canada), for editorial assistance. We also acknowledge Shalini Santhakumaran, MSc, and Eugene Statnikov, MSc (Neonatal Data Analysis Unit, United Kingdom), for their help in the planning stages of analyses and in data extraction.
© 2016 Elsevier Inc.
- bronchopulmonary dysplasia
- composite outcome
- peri-intraventricular hemorrhage
- periventricular echodensity/echolucency
- preterm birth
- quality improvement
- retinopathy of prematurity