4 Outborn Preterm Infants: Outcome Based on Place of Admission – Perinatal Centres vs Free Standing Pediatric Hospitals
Bibliographic record
Abstract
A previous report from Canadian Neonatal Network (CNN) revealed that even after adjustments of perinatal risks and admission illness severity, inborn infants had better outcomes compared to out-born infants. It was speculated that lack of availability of specialist support, staffing, expertise and equipment might be related to the poor outcomes in outborn infants. The objective of this study was to examine whether admission hospital type was associated with differences in mortality and morbidity among preterm infants who were born outside the perinatal centres, after adjustment of perinatal risks and admission illness severity (using the Score of Neonatal Acute Physiology, version II). Data was obtained from the Canadian Neonatal Network database. Multiple regression analyses were used to compare the risk-adjusted outcome of 605 outborn singleton infants born at < 32 weeks gestation, admitted to either 13 perinatal centres or 4 free standing pediatric hospitals in Canada during 1996–1997. There was no difference in the gestational age, apgar score, delivery type, prenatal care or SNAP II score between infants admitted to both types of hospitals. Maternal hypertension and administration of complete course of prenatal corticosteroid were more common among infants admitted to free standing pediatric hospitals. Outborn infants admitted to free standing pediatric hospitals were at higher risk of death (adjusted odds ratio [OR] 2.25, 95% confidence interval [CI] 1.20, 4.20), nosocomial infection (adjusted OR 2.48, 95% CI 1.64, 3.73) and oxygen dependency at 28 days of age (adjusted OR 1.77, 95% CI 1.14, 2.75); and at lower risk for developing PDA (adjusted OR 0.46, 95% CI 0.30, 0.69) and lower risk of CPAP dependency at 28 days (adjusted OR 0.66, 95% CI 0.47, 0.93); even after adjustment of perinatal risks and admission illness severity. After adjustment for perinatal risks and admission illness severity, outborn infants had better outcomes if they were admitted to perinatal centres compared to free standing pediatric hospitals. Our results indicate that if in-utero maternal transfers are not possible due to reasons beyond control, efforts should be made to transfer preterm infants to perinatal centres.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".