Variation in hospital morbidities in an Australian neonatal intensive care unit network

Objective: There is an expectation among the public and within the profession that the performance and outcome of neonatal intensive care units (NICUs) should be comparable between centres with a similar setting. This study aims to benchmark and audit performance variation in a regional Australian network of eight NICUs. Design: Cohort study using prospectively collected data. SettingL All eight perinatal centres in New South Wales and the Australian Capital Territory, Australia. Patients: All live-born infants born between 23+0 and 31+6 weeks gestation admitted to one of the tertiary perinatal centres from 2007 to 2020 (n=12 608). Main outcome measures: Early and late confirmed sepsis, intraventricular haemorrhage, medically and surgically treated patent ductus arteriosus, chronic lung disease (CLD), postnatal steroid for CLD, necrotising enterocolitis, retinopathy of prematurity (ROP), surgery for ROP, hospital mortality and home oxygen. Results: NICUs showed variations in maternal and neonatal characteristics and resources. The unadjusted funnel plots for neonatal outcomes showed apparent variation with multiple centres outside the 99.8% control limits of the network values. The hierarchical model-based risk-adjustment accounting for differences in patient characteristics showed that discharged home with oxygen is the only outcome above the 99.8% control limits. Conclusions: Hierarchical model-based risk-adjusted estimates of morbidity rates plotted on funnel plots provide a robust and straightforward visual graphical tool for presenting variations in outcome performance to detect aberrations in healthcare delivery and guide timely intervention. We propose using hierarchical model-based risk adjustment and funnel plots in real or near real-time to detect aberrations and start timely intervention

Neonatal abstinence syndrome and high school performance

BACKGROUND AND OBJECTIVES: Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). METHODS: Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. RESULTS: Mean test scores (range 0-1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 2.2-2.7), indigenous status (aOR, 2.2; 95% CI, 2.2-2.3), male gender (aOR, 1.3; 95% CI, 1.3-1.4), and low parental education (aOR, 1.5; 95% CI, 1.1- 1.6), with all Ps < .001. CONCLUSIONS: A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes

Prikazi

Stef Jansen, Razlog za dom (Lj. Anđelković Džambić); Music and Dance in Southeastern Europe. Migrations, Carnival, Sustainable Development, Liz Mellish, Nick Green i Tvrtko Zebec, ur. (B. Majnarić); Encountering Fear, Natka Badurina, Una Bauer, Renata Jambrešić Kirin i Jelena Marković, ur. (L. Stevanović); Damir Zorić, Silva rerum. Bilješke o ishodištima pučkih tradicija (L. Bajuk); Ivan Marković, Uvod u verbalni humor (D. Nikolić); Aida Brenko, Mareta Kurtin, Vesna Zorić, “Kapa dolje!” Priča o (ne)pokrivanju glave (A. Gruić Parać); Simon Beames, Chris Mackie i Matthew Atencio, Adventure and Society (S. Đurin); The Balkan Route. Historical Transformations from Via Militaris to Autoput, Florian Riedler i Nenad Stefanov, ur. (M. Hameršak); Lidija Delić, Mirjana Detelić i Ljiljana Pešikan-Ljuštanović, Glavit junak i ostala gospoda. Analize narodnih pesama (S. Marjanić); Ekofeminizam. Između zelenih i ženskih studija, Goran Đurđević i Suzana Marjanić, ur. (A. Stojanović); Bruno Ćurko i Stipe Surać, Mediteranski armerun. Jadranske letere i litrati. Fotobrevijarij s interaktivnom kartom Jadrana (S. Delić); Tora Holmberg, Urban Animals. Crowding in Zoocities (I. Filip); Maurizio Catino, Mafia Organizations. The Visible Hand of Criminal Enterprise (V. Benković); Groblja. Književno-kulturna materijalizacija smrti, Dragan Bošković, ur. (D. Vlaisavljević); Drugi bosanskohercegovački slavistički kongres. Zbornik radova, knj. 2, Senahid Halilović, ur. (R. Šutalo); Jadran Kale, Raprostiranje kulture. Kako ljudi stvaraju prostor (K. Hrobat Virloget

Prikazi

Stef Jansen, Razlog za dom (Lj. Anđelković Džambić); Music and Dance in Southeastern Europe. Migrations, Carnival, Sustainable Development, Liz Mellish, Nick Green i Tvrtko Zebec, ur. (B. Majnarić); Encountering Fear, Natka Badurina, Una Bauer, Renata Jambrešić Kirin i Jelena Marković, ur. (L. Stevanović); Damir Zorić, Silva rerum. Bilješke o ishodištima pučkih tradicija (L. Bajuk); Ivan Marković, Uvod u verbalni humor (D. Nikolić); Aida Brenko, Mareta Kurtin, Vesna Zorić, “Kapa dolje!” Priča o (ne)pokrivanju glave (A. Gruić Parać); Simon Beames, Chris Mackie i Matthew Atencio, Adventure and Society (S. Đurin); The Balkan Route. Historical Transformations from Via Militaris to Autoput, Florian Riedler i Nenad Stefanov, ur. (M. Hameršak); Lidija Delić, Mirjana Detelić i Ljiljana Pešikan-Ljuštanović, Glavit junak i ostala gospoda. Analize narodnih pesama (S. Marjanić); Ekofeminizam. Između zelenih i ženskih studija, Goran Đurđević i Suzana Marjanić, ur. (A. Stojanović); Bruno Ćurko i Stipe Surać, Mediteranski armerun. Jadranske letere i litrati. Fotobrevijarij s interaktivnom kartom Jadrana (S. Delić); Tora Holmberg, Urban Animals. Crowding in Zoocities (I. Filip); Maurizio Catino, Mafia Organizations. The Visible Hand of Criminal Enterprise (V. Benković); Groblja. Književno-kulturna materijalizacija smrti, Dragan Bošković, ur. (D. Vlaisavljević); Drugi bosanskohercegovački slavistički kongres. Zbornik radova, knj. 2, Senahid Halilović, ur. (R. Šutalo); Jadran Kale, Raprostiranje kulture. Kako ljudi stvaraju prostor (K. Hrobat Virloget

Posodobljena priporočila diagnostike in zdravljenja diferenciranega raka ščitnice

no abstractni abstrakt

Using hospital discharge data for determining neonatal morbidity and mortality: a validation study

<p>Abstract</p> <p>Background</p> <p>Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU) admissions.</p> <p>Methods</p> <p>Validation study of population-based linked hospital discharge/birth data against neonatal intensive care audit data from New South Wales, Australia for 2,432 babies admitted to NICUs, 1994–1996. Sensitivity, specificity and positive predictive values (PPV) with exact binomial confidence intervals were calculated for 12 diagnoses and 6 procedures.</p> <p>Results</p> <p>Sensitivities ranged from 37.0% for drainage of an air leak to 97.7% for very low birthweight, specificities all exceeded 85% and PPVs ranged from 70.9% to 100%. In-hospital mortality, low birthweight (≤1500 g), retinopathy of prematurity, respiratory distress syndrome, meconium aspiration, pneumonia, pulmonary hypertension, selected major anomalies, any mechanical ventilation (including CPAP), major surgery and surgery for patent ductus arteriosus or necrotizing enterocolitis were accurately identified with PPVs over 92%. Transient tachypnea of the newborn and drainage of an air leak had the lowest PPVs, 70.9% and 83.6% respectively.</p> <p>Conclusion</p> <p>Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.</p

Perinatal care at the borderlines of viability: a consensus statement based on a NSW and ACT consensus workshop

Perinatal care at the borderlines of viability demands a delicate balance between parents’ wishes and autonomy, biological feasibility, clinicians’ responsibilities and expectations, and the prospects of an acceptable long-term outcome — coupled with a tolerable margin of uncertainty. A multi-professional workshop with consumer involvement was held in February 2005 to agree on management of this issue in New South Wales and the Australian Capital Territory. Participants discussed and formulated consensus statements after an extensive consultation process. Consensus was reached that the “grey zone” is between 23 weeks’ and 25 weeks and 6 days’ gestation. While there is an increasing obligation to treat with increasing length of gestation, it is acceptable medical practice not to initiate intensive care during this period if parents so wish, after appropriate counselling. Poor condition at birth and the presence of serious congenital anomalies have an important influence on any decision not to initiate intensive care within the grey zone. Women at high risk of imminent delivery within the grey zone should receive appropriate and skilled counselling with the most relevant up-to-date outcome information. Management plans can thus be made before birth. Information should be simple, factual and consistent. The consensus statements developed will provide a framework to assist parents and clinicians in communication, decision making and managing these challenging situations

Actuarial day-by-day survival rates of preterm infants admitted to neonatal intensive care in New South Wales and the Australian Capital Territory

To characterise the actuarial day-by-day survival of premature infants in a geographically defined population. 10 Neonatal Intensive Care Units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia. Retrospective analysis of

Does timing of initial surfactant treatment make a difference in rates of chronic lung disease or mortality in premature infants? An observational regional study

Objective: To compare two treatment strategies in preterm infants with or at risk of respiratory distress syndrome: early surfactant administration (within one hour of birth) versus late surfactant administration, in a geographically defined population.Outcome: The primary outcome was chronic lung disease (CLD) and mortality before/at 36 weeks. Secondary outcomes included: duration of mechanical ventilation and continuous positive airway pressure (CPAP), post-natal steroids for CLD and major neonatal morbidities.Subjects: Premature infants born at 22-32 weeks gestation between January 2006 and December 2009.Setting: Ten neonatal intensive care units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia.Design: Retrospective analysis of prospectively collected data from the regional NICU database in NSW and ACT.Results: Of the 2170 infants who received surfactant, 1182 (54.5%) and 988 (45.5%) received early and late surfactant, respectively. The early surfactant group was less mature (27.1 ± 2.1 versus 29.4 ± 2.1 weeks) and had more CLD and mortality (40.2% versus 20.0%). The multivariable analysis showed early surfactant to be associated with less duration of ventilation, longer duration of CPAP and longer hospital stay but had little or no impact on CLD/mortality.Conclusion: Early surfactant administration is associated with shorter duration of ventilation but does not appear to be significantly protective against CLD/mortality among premature infants. This may support the growing evidence for consideration of CPAP as an alternative to routine intubation and early surfactant administration. Further investigation from large randomized clinical trials is warranted to confirm these results