Explore the vast range of titles available.

ObjectiveTo examine the association between preterm delivery and parental separation and identify associated risk factors.MethodsAll opposite sex, married or common-law parents whose relationship status was available at index delivery and for the next 5 years were eligible in this retrospective population-based cohort study in Manitoba, Canada. Parents of children born preterm were matched 1:5 to parents of children born full-term. Parental separation within 5 years of childbirth was the primary outcome. Secondary outcome was the time to separation. Multivariable Poisson regression model was created to estimate the 5-year incidence rate ratios (IRR) of the primary outcome.ResultsParents of 6367 children born preterm (n=164 for <28 weeks, n=1196 for 28–33 weeks, n=5007 for 34–36 weeks) and parents of 30 663 children born full-term were included. Compared with parents of children born term (4.2%), only parents of children born at 34–36 weeks had a higher incidence rate of separation (5.5%, IRR: 1.26; 1.09–1.45, p=0.002), although parents of children born at 28–33 weeks (5.4%, IRR: 1.20; 0.93–1.55, p=0.16), and at<28 weeks (5.5%, IRR: 1.27; 0.66–2.45, p=0.48) had similar IRRs. Time to separation was similar between all groups.ConclusionsParents of children born at 34–36 weeks had higher separation rates than parents of children born full-term. The risk factors identified can be used to identify and provide supports to at-risk parents.

IntroductionVentilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among neonates requiring life-saving mechanical ventilation in neonatal intensive care units (NICUs), particularly those who are born prematurely and/or with very-low-birth-weight (VLBW), or critically ill. Despite its clinical significance, neonatal VAP lacks standardised diagnostic criteria, resulting in variability in incidence reporting, over or under diagnosis and inappropriate antimicrobial use which further exacerbates the emergence of antibiotic-resistant organisms. Current diagnostic criteria and prevention strategies, often adapted from paediatric populations and adults, fail to address the unique anatomical and clinical characteristics of neonates. Building on a pilot investigation across Canadian NICUs, the goal of this study is to establish standardised, neonatal-specific VAP diagnostic criteria and prevention strategies to improve diagnostic accuracy, promote antimicrobial stewardship and enhance clinical outcomes.Methods and analysisBeginning in 2025, a 4-year, multicentre, prospectively-designed retrospective cohort study will be conducted across tertiary NICUs in Canada. All VLBW (birth weight <1500 g) neonates admitted to participating NICUs will be included. Our first aim is to use the Canadian Neonatal Network (CNN) platform, integrated with advanced data screening tools, to collect standardised demographic, clinical, ventilatory and microbiological data to assess VAP incidence and outcomes based on existing definitions. Next, we will develop a neonatal-specific VAP diagnostic criteria, by combining statistical analyses, including univariate analysis, multivariable logistic regression and receiver operating characteristic analyses, with expert consensus building through the Delphi method. Concurrently, we will focus on implementing evidence-based VAP prevention strategies and evaluate outcome measures, such as VAP incidence, adherence to prevention bundles and antimicrobial stewardship practices.Ethics and disseminationThis study has received ethics approval from the University of Alberta Health Research Ethics Board-Health Panel (Pro00149177). Findings will be disseminated through open-access publications, conference presentations and online platforms to promote widespread adoption.Trial registration numberNCT07109791.

IntroductionPatent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in preterm infants and evidence regarding the best treatment approach is lacking. Currently available medical options to treat a PDA include indomethacin, ibuprofen or acetaminophen. Wide variation exists in PDA treatment practices across Canada. In view of this large practice variation across Canadian neonatal intensive care units (NICUs), we plan to conduct a comparative effectiveness study of the different pharmacotherapeutic agents used to treat the PDA in preterm infants.Methods and analysisA multicentre prospective observational comparative-effectiveness research study of extremely preterm infants born <29 weeks gestational age with an echocardiography confirmed PDA will be conducted. All participating sites will self-select and adhere to one of the following primary pharmacotherapy protocols for all preterm babies who are deemed to require treatment.Standard dose ibuprofen (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals) irrespective of postnatal age (oral/intravenous).Adjustable dose ibuprofen (oral/intravenous) (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals if treated within the first 7 days after birth. Higher doses of ibuprofen up to 20 mg/kg followed by two doses of 10 mg/kg at 24 hours intervals if treated after the postnatal age cut-off for lower dose as per the local centre policy).Acetaminophen (oral/intravenous) (15 mg/kg every 6 hours) for 3–7 days.Intravenous indomethacin (0.1–0.3 mg/kg intravenous every 12–24 hours for a total of three doses).OutcomesThe primary outcome is failure of primary pharmacotherapy (defined as need for further medical and/or surgical/interventional treatment following an initial course of pharmacotherapy). The secondary outcomes include components of the primary outcome as well as clinical outcomes related to response to treatment or adverse effects of treatment.Sites and sample sizeThe study will be conducted in 22 NICUs across Canada with an anticipated enrollment of 1350 extremely preterm infants over 3 years.AnalysisTo examine the relative effectiveness of the four treatment strategies, the primary outcome will be compared pairwise between the treatment groups using χ2 test. Secondary outcomes will be compared pairwise between the treatment groups using χ2 test, Student’s t-test or Wilcoxon rank sum test as appropriate. To further examine differences in the primary and secondary outcomes between the four groups, multiple logistic or linear regression models will be applied for each outcome on the treatment groups, adjusted for potential confounders using generalised estimating equations to account for within-unit-clustering. As a sensitivity analysis, the difference in the primary and secondary outcomes between the treatment groups will also be examined using propensity score method with inverse probability weighting approach.Ethics and disseminationThe study has been approved by the IWK Research Ethics Board (#1025627) as well as the respective institutional review boards of the participating centres.Trial registration numberNCT04347720.

ObjectiveTo evaluate the impact of a targeted neonatal echocardiography (TNE) service on patient management in the neonatal intensive care units (NICU) in Winnipeg, Canada.Study designRetrospective cohort study of neonates who had TNEs from 2014 to 2019. The primary outcome was the change in clinical management based on TNE recommendation. Multivariate logistic regression analysis was used to identify predictors of the primary outcome.ResultsA total of 747 echos were performed on 307 neonates. Patent ductus arteriosus assessment was the most common indication for TNE followed by evaluation of pulmonary hypertension and systemic hemodynamics. TNE led to a change in clinical management following 492 (66%) echos. Mechanical ventilation [Odds ratio (OR) 2.4, 95% CI: 1.7–3.4, P < 0.001) and receiving inhaled nitric oxide (1.9, 95% CI: 1.3−3.0, P = 0.003) were the predictors for the change in clinical management following TNE.ConclusionTNE has enhanced patient care by altering the management of patients in the NICU.

ObjectiveTo evaluate the utility of a point of care lung ultrasound (POC-LUS) on patient management in the Neonatal Intensive Care Unit (NICU).Study designA retrospective cohort study of neonates who had POC-LUS from 2016 to 2020 in two-level III NICUs in Winnipeg, Manitoba, Canada. The primary outcome was the change in clinical management. The analysis aims mainly to describe the implementation process of the POC-LUS program.ResultsA total of 956 neonates underwent 4076 POC-LUS studies during the study period. The number of POC-LUS studies increased significantly every year, from 316 (in 2016) to 1257 (in 2020) (p < 0.001). POC-LUS resulted in a change in clinical management following 2528 POC-LUS studies (62%), while it supported continuing the same management in 1548 studies (38%).ConclusionPOC-LUS in Manitoba increased since its inception and led to an alteration in the clinical management in a significant proportion of patients who received the service.

BackgroundHypertensive disorders of pregnancy (HDP) are associated with dysfunctional placentation and are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancies have a larger placental mass and are a risk factor for HDP. The effect of HDP on neonatal outcomes in twin pregnancies is unknown.MethodsRetrospective cohort study using the Canadian Neonatal Network database from 2010–2018 of twin infants <29 weeks gestation born to mothers with HDP and normotensive pregnancies. Using multivariable models, we determined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for mortality, bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity (ROP), necrotizing enterocolitis, and nosocomial infection in twin infants of mothers with HDP compared to twin infants of normotensive mothers.ResultsOf the 2414 eligible twin infants <29 weeks gestational age, 164 (6.8%) were born to mothers with HDP and had higher odds of severe ROP (AOR 2.48, 95% CI 1.34–4.59). Preterm twin infants born to mothers with HDP also had higher odds of mortality (AOR 2.02, 95% CI 1.23–3.32). There was no difference in other outcomes.ConclusionPreterm twin infants <29 weeks gestation of HDP mothers have higher odds of severe ROP and mortality.ImpactHypertensive disorders of pregnancy, associated with placental dysfunction, are a major cause of maternal and neonatal morbidity and mortality.Twin pregnancy, associated with a larger placental mass, is a risk factor for hypertensive disorders of pregnancy.The effect of hypertensive disorders of pregnancy on outcomes of preterm twins is unknown.Preterm twins of mothers with hypertensive disorders of pregnancy are at higher risk of severe retinopathy of prematurity and mortality.Our data can be used to counsel parents and identify infants at higher risk of severe retinopathy of prematurity and mortality.

Importance Data on the middle school outcomes of preterm children are limited and have methodologic issues. Objective To study the association between preterm birth and grade 7 school performance. Methods A retrospective population-based cohort study of children born in Manitoba, Canada between 1994 and 2006 using their grade 7 school performance data. A secondary sibling cohort was created comprising children born preterm and their full-term siblings. Primary exposure was preterm birth categorized as <28, 28–33 and 34–36 weeks gestation. The two co-primary grade 7 outcome measures were: not meeting the mathematics competencies, and not meeting the student engagement competencies. Multivariable logistic regression models tested the association between preterm birth and both co-primary outcomes; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Results 7653 preterm (gestational age median [IQR]: 35 weeks [34,36]) and 110,313 term (40 [39,40]) were included. 43% of < 28 weeks, 18% of 28–33 weeks and 17% of 34–36 weeks had the mathematics co-primary outcome compared to 13% of term children. The corresponding % for the student engagement outcome were 42%, 24%, 24% and 24% respectively. Preterm birth was associated with the mathematics (<28 weeks: 5.48, 3.89–7.70; 28–33 weeks: 1.47, 1.27–1.70; 34–36 weeks: 1.26, 1.16–1.35) and student engagement outcomes (<28 weeks: 2.49, 1.76–3.51; 28–33 weeks: 1.21, 1.06–1.39; 34–36 weeks: 1.09, 1.01–1.16). However, there was no difference in outcomes among the sibling cohort. Conclusions and relevance Children born preterm had lower grade 7 performance compared to children born term in this population-based cohort. Screening and supports for them in their middle school years are warranted.

ObjectiveTo study the association between prematurity and grade 3 school performance in a contemporary cohort of children.MethodsPopulation-based retrospective cohort study in Manitoba, Canada. Children born between 1999 and 2011 who had their grade 3 school performance data available were eligible. Preterm birth (<37 weeks) was the exposure of interest assessed using multivariable logistic regression models. Our primary outcomes were ‘needs ongoing help’ or ‘outside the range’ in at least two of each of the (1) four numeracy and (2) three reading competencies.ResultsOf the 186 956 eligible children, 101 436 children (7187 preterm (gestational age, median (IQR) 35 weeks (34, 36)) and 94 249 term (40 weeks (39,40)) were included. Overall, 19% of preterm and 14% of term children had the numeracy outcome (adjusted OR (aOR) 1.38; 95% CI 1.29 to 1.47, p<0.001), while 19% and 13% had the reading outcome (aOR 1.38; 1.29 to 1.48, p<0.001). These differences showed a gestational age gradient. Gestational age (for numeracy, <28 weeks aOR 4.93 (3.45 to 7.03), 28–33 weeks 1.72 (1.50 to 1.98), 34–36 weeks 1.24 (1.15 to 1.34); for reading, <28 weeks 3.51 (2.40 to 5.14), 28–33 weeks 1.72 (1.49 to 1.98), 34–36 weeks 1.24 (1.17–1.37)), male sex, small for gestational age and maternal medical and sociodemographic factors were associated with the numeracy and reading outcomes in this cohort.Conclusions and relevanceChildren born preterm had poorer performance in grade 3 numeracy and reading proficiencies than children born full term. All children born preterm, not just those born extremely preterm, should be screened for reading and numeracy performance in school and strategies implemented to address any deficits.

ObjectiveTo describe the utilization and study the factors associated with the impact on clinical management of a new TNE consultation service in a perinatal center.MethodsThis retrospective cohort study included all neonates who underwent TNE consultation at the neonatal unit of Mount Sinai Hospital in Toronto, Canada (November 2011 and July 2015). The consults that had “impact” were defined as those that led to a TNE suggested change in the clinical management within 6 h of its recommendation. Logistic regression analysis was performed to identify factors associated with a change in clinical management following the consultation.ResultsA total of 553 consults were performed for 268 infants (gestational age: 27 ± 4 weeks and age at initial consult: 16 (5, 34) days). Patent ductus arteriosus (PDA, 61%), suspected pulmonary hypertension (PH, 27%), and systemic hypotension (SH, 9%) were the common indications. The average consultations increased from 9 in 2012–2013 to 20 per month in 2014–2015. Forty eight percent of consults had an impact on clinical management (PDA scans: 38%, PH: 58%, and SH: 81%, p < 0.01 between all). Male gender (adjusted odds ratio (95% confidence interval): 1.9 (1.0, 3.5); p = 0.04), mechanical ventilation (2.43 (1.2, 4.9); p = 0.01), and scans for PH (7.1 (2.2, 23.2); p < 0.01) and SH (2.6 (1.1, 6.5); p = 0.03) were independently associated with the impact on clinical management. TNE consults identified all incidental cases of major structural defects (n = 4), and six out of ten minor diagnoses.ConclusionsTNE consult service demonstrated an increasing utilization and a significant impact on clinical management over time especially for non-PDA indications and in situations of high-illness severity. Although, all major cardiac defects were identified, some minor congenital defects were missed by TNEs.

ObjectiveTo compare the characteristics and outcomes of neonates with mild hypoxic-ischemic encephalopathy (HIE) who received hypothermia versus standard care.Study designWe conducted a retrospective cohort study of neonates ≥35 weeks’ gestation and ≥1800 g admitted with a diagnosis of Sarnat stage 1 encephalopathy. We evaluated length of hospital stay, duration of ventilation, evidence of brain injury on MRI, and neonatal morbidities.ResultsOf 1089 eligible neonates, 393 (36%) received hypothermia and 595 (55%) had neuroimaging. The hypothermia group was more likely to be outborn, born via C-section, had lower Apgar scores, and required extensive resuscitation. They had longer durations of stay (9 vs. 6 days, P < 0.001), respiratory support (3 vs. 2 days, P < 0.001), but lower odds of brain injury on MRI (adjusted odds ratio 0.33, 95% CI: 0.22–0.52) compared with standard care group.ConclusionDespite prolongation of hospital stay, hypothermia may be potentially beneficial in neonates with mild HIE; however, selection bias cannot be ruled out.