747 Review of practices around perinatal sentinel events of preterm babies with severe neurological injury in a single tertiary care centre in Canada
Notice bibliographique
Résumé
Background Preterm infants born <33 weeks gestational age (GA) are at risk of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) in the early peri-natal period. Grades 3 and 4 IVH and PVL are considered severe neurological injury (SNI) and the prevalence of neurodevelopmental disability in survivors is high. Objectives This project aims to analyze practices and trends over a 10 years span, around major sentinel events, which are known to have contributory role in causality of SNI in preterm babies, in a single tertiary care, level 3 NICU with a higher rate of SNI compared to the national annual rates according to the Canadian Neonatal Network (CNN). Methods The nation-wide Evidence Based Practice for Improving Quality (EPIQ) Guidelines have an enlisted set of sentinel events with levels of recommendations spanning multiple disciplines, to reduce the SNI in this population. We assessed practices around each antenatal, intrapartum and early postnatal sentinel event. A total of 42 sentinel events were analyzed in a retrospective cohort of babies who were born <33 weeks and went on to have SNI. These babies were born between January 1, 2010 to December 31, 2019. Antenatal events reviewed were steroids, presence of chorioamnionitis or abruption; intrapartum events like MgSO4, mode of delivery, fetal bradycardia. Postnatal events looked into were resuscitation, intubation, pain and temperature management, hemodynamic and ventilation strategies and hematological parameters like platelet count and sodium levels, till 72 hours of life. Babies with major congenital anomalies, antenatally diagnosed brain injury, and infants transferred after 72 hours of life were excluded. Results Of the cohort of 134 babies that met inclusion criteria, 31.1% are outborn and 50% are ≤26 weeks. The median SNAP II score was 21. Through the 10 years, outborn babies were consistently seen to have significantly low incidence of antenatal steroids (p 0.001) and MgSO4 (p 0.001) and were more likely to become hypothermic (p 0.017) or need multiple intubation attempts at delivery (p 0.009). The ≤26 weeks cohort who went on to incur a SNI, were significantly more likely to be hypernatremic (p 0.001), hypercarbic (p 0.010) with acidosis (p 0.013) requiring bi-carbonate infusion (p 0.002) and inotropic support (p 0.015). The rates of delayed cord clamping (DCC) could not be commented on as the documentation was variable with different definition of ‘delayed’ being used throughout the province. Conclusions This study sheds light on practices carried out in a particularly populated province in Canada and highlights potential areas requiring focus so as to improve rates of SNI in this unit. It also aims to address areas to improve documentation like DCC in the CNN database. Timely maternal transfer to tertiary care and enhancing perinatal care in referral centers, specifically increasing use of MgSO4 and reducing hypothermia, remain a priority in this province. Among infants <26 weeks higher rates of hypernatremia and hypercapnia were identified as somewhat modifiable risk factors associated with SNI. Considering half the cohort was >26 weeks, it is crucial to improve adoption of evidence-based neuroprotective strategies for all infants <33 weeks GA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,008 | 0,021 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».