Trends in Maternal-Neonatal Care and Outcomes

We focused on changes over time in maternal and neonatal care practices and neonatal morbidity and mortality. Changes in maternal/neonatal characteristics, including maternal age, race/ethnicity (based on chart abstraction using categories specified in the study manual of operations), prenatal care, insulin-dependent diabetes, hypertension; multiple birth; birth defects; infant GA, BW, and small for GA were examined to assess changes over time that might influence outcomes. Care practices reported were chosen because they have been associated with neonatal outcomes and included antenatal steroids, antenatal antibiotics, cesarean delivery, delivery room resuscitation, surfactant therapy, postnatal steroids, and respiratory support. Morbidities included necrotizing enterocolitis, stage 2–3 (NEC)^{16 (link),17 (link)}; early (≤72 hours) and late-onset (>72 hours) sepsis, defined by cultures positive for bacteria or fungi, and antibiotic therapy ≥5 days or intent to treat but death <5 days^{18 (link),19 (link)}; intracranial hemorrhage (ICH); cystic periventricular leukomalacia (PVL); retinopathy of prematurity (ROP) among infants hospitalized at 28 days; and bronchopulmonary dysplasia (BPD), defined as oxygen use at 36 weeks postmenstrual age or at discharge/transfer if before 36 weeks in infants who survived to 36 weeks. ICH was based on the most severe cranial sonogram prior to hospital discharge, transfer, or death. Grade 3/4 ICH was considered severe.^{20 (link)} Survival to discharge and survival without major morbidity (NEC, severe ICH, PVL, early or late-onset sepsis or meningitis, BPD or ROP ≥stage 3) were studied.

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Stoll B.J., Hansen N.I., Bell E.F., Walsh M.C., Carlo W.A., Shankaran S., Laptook A.R., Sánchez P.J., Van Meurs K.P., Wyckoff M., Das A., Hale E.C., Ball M.B., Newman N.S., Schibler K., Poindexter B.B., Kennedy K.A., Cotten C.M., Watterberg K.L., D’Angio C.T., DeMauro S.B., Truog W.E., Devaskar U, & Higgins R.D. (2015). Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012. JAMA, 314(10), 1039-1051.

Publication 2015

Antibiotic Antibiotics Bacteria Birth defects Bronchopulmonary dysplasia Cesarean delivery Cranial sonogram Cystic periventricular leukomalacia Discharge Ethnicity Fungi Hypertension Infants Insulin dependent diabetes Intracranial hemorrhage Maternal Meningitis Multiple birth Necrotizing enterocolitis Neonatal Oxygen Periventricular leukomalacia Prenatal care Respiratory Resuscitation Retinopathy of prematurity Sepsis Steroids Surfactant Therapy

Corresponding Organization :

Other organizations : Children's Healthcare of Atlanta, Emory University, RTI International, University of Iowa, Case Western Reserve University, Rainbow Babies & Children's Hospital, University of Alabama at Birmingham, Wayne State University, Women & Infants Hospital of Rhode Island, Providence College, Brown University, Nationwide Children's Hospital, The Ohio State University, Lucile Packard Children's Hospital, Stanford University, The University of Texas Southwestern Medical Center, Cincinnati Children's Hospital Medical Center, Indiana University – Purdue University Indianapolis, Duke University, University of New Mexico, University of Rochester, University of Pennsylvania, Children's Mercy Hospital, University of California, Los Angeles, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development

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Variable analysis

independent variables

Maternal age
Race/ethnicity
Prenatal care
Insulin-dependent diabetes
Hypertension
Multiple birth
Birth defects
Infant GA
Infant BW
Infant small for GA

dependent variables

Antenatal steroids
Antenatal antibiotics
Cesarean delivery
Delivery room resuscitation
Surfactant therapy
Postnatal steroids
Respiratory support
Necrotizing enterocolitis (NEC) stage 2-3
Early (≤72 hours) and late-onset (>72 hours) sepsis
Intracranial hemorrhage (ICH)
Cystic periventricular leukomalacia (PVL)
Retinopathy of prematurity (ROP)
Bronchopulmonary dysplasia (BPD)
Survival to discharge
Survival without major morbidity

control variables

Maternal/neonatal characteristics
Care practices
Morbidities

Annotations

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