121 The Cumulative Effect of Evidence-Based Practices on Outcomes of Preterm Infants Born <29 Weeks
Bibliographic record
Abstract
Extremely preterm infants born <29 weeks’ gestation are at high risk of death or severe neurological injury (SNI; ≥grade 3 intraventricular hemorrhage and/or periventricular leukomalacia). Individual studies of four evidence-based practices (EBPs) have been associated with reductions in death/SNI. To investigate the cumulative effect of four EBPs and their association with death/SNI among infants born <29 weeks. Observational study of infants born 230-286weeks admitted in NICUs participating in the Canadian Neonatal Network from 2013–2017.EBPs included: antenatal MgSO4for neuroprotection (MgSO4), antenatal corticosteroids (ACS), delayed cord clamping ≥30 seconds (DCC)and normothermia on admission (NT). The effect of exposure to one, two, three and all four EBPs was assessed using multivariate logistic regression models adjusted for patient characteristics. Rate of death/SNI was 26% (966/3788) in the cohort. Rate of exposure to EBPs was: none, 3% (132); one, 16% (606); two, 36% (1362); three, 33% (1267); all, 11% (421). Significantly lower odds of death/SNI were observed with exposure to ACS (adjusted odds ratio [AOR] 0.60, 95% CI 0.50–0.72) and DCC (AOR 0.77, 95% CI 0.61–0.98) but not with MgSO4(AOR 0.87, 95% CI 0.71–1.05) and NT (AOR 0.93, 95% CI 0.55–1.13). Infants exposed to two EBPs had significantly lower odds of death/SNI than those not exposed to any EBPs (25% [346/1362] vs 37% [49/132], AOR 0.70, 95% CI 0.66-0.60). Exposure to increasing number of EBPs was associated with decreasing odds of death/SNI (Table 1). Among infants born <29 weeks’ gestation, exposure to higher number of EBPs is associated with decreasing odds of death/SNI. Increasing compliance with implementation of these four EBP should be the goal to improve outcomes.
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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 | 0.011 | 0.061 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 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".