The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care

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Abstract

Background

The International Network for Evaluating Outcomes in Neonates (iNeo) is a collaboration of population-based national neonatal networks including Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the UK. The aim of iNeo is to provide a platform for comparative evaluation of outcomes of very preterm and very low birth weight neonates at the national, site, and individual level to generate evidence for improvement of outcomes in these infants.

Methods/design

Individual-level data from each iNeo network will be used for comparative analysis of neonatal outcomes between networks. Variations in outcomes will be identified and disseminated to generate hypotheses regarding factors impacting outcome variation. Detailed information on physical and environmental factors, human and resource factors, and processes of care will be collected from network sites, and tested for association with neonatal outcomes. Subsequently, changes in identified practices that may influence the variations in outcomes will be implemented and evaluated using quality improvement methods.

Discussion

The evidence obtained using the iNeo platform will enable clinical teams from member networks to identify, implement, and evaluate practice and service provision changes aimed at improving the care and outcomes of very low birth weight and very preterm infants within their respective countries. The knowledge generated will be available worldwide with a likely global impact.

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Most cited references 53

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Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.

Suzanna Dunn, K Lennox, A T Shennan … (1988)

The follow-up records of 605 infants with birth weights of less than 1,500 g, with data available for 2 years after birth, were examined for evidence of abnormal pulmonary signs or symptoms. A total of 119 infants were identified and the neonatal oxygen requirements of these infants were compared with those of 486 infants who had normal pulmonary function. A requirement for oxygen at 28 days of life had a positive predictive value for abnormal pulmonary findings at the time of follow-up of only 38%, whereas 31% of those with normal pulmonary findings at the time of follow-up were still receiving oxygen at this age. The need for oxygen at 28 days was a good predictor of abnormal findings in infants of greater than or equal to 30 weeks' gestational age at birth but became increasingly less useful as gestational age decreased. It was found that, irrespective of gestational age at birth, the requirement for additional oxygen at 36 weeks' corrected postnatal gestational age was a better predictor of abnormal outcome, increasing the positive predictive value to 63%. The prediction of a normal outcome remained 90% for infants not receiving oxygen at this corrected gestational age.

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CRIB II: an update of the clinical risk index for babies score.

William Tarnow-Mordi, Janet Tucker, Gareth Parry (2003)

The clinical risk index for babies (CRIB) score is a risk-adjustment instrument widely used in neonatal intensive care. Its appropriateness with contemporary data has been questioned. We have examined these questions, developed a new five-item CRIB II score with data from a UK-wide sample of infants admitted to neonatal intensive care in 1998-99, and shown how mortality after neonatal intensive care has fallen in the past 12 years. CRIB II provides a recalibrated and simplified scoring system that avoids the potential problems of early treatment bias. A valid and simple method of risk-adjustment for neonatal intensive care is important to ensure accurate assessment of quality of care. Such assessments should be done in tandem with national audit systems for neonatal intensive care, incorporating measures of morbidity as well as mortality.

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Trends in mortality and morbidity for very low birth weight infants, 1991-1999.

Gary Badger, Jeffrey Horbar, Eric Kilpatrick … (2002)

Medical care for very low birth weight (VLBW) infants and their mothers has changed dramatically during the 1990s, yet it is unclear how these changes have affected mortality and morbidity. We used the Vermont Oxford Network Database to identify trends in clinical practice and patient outcomes for VLBW infants born from 1991 to 1999. Logistic regression was used to evaluate temporal trends in practices and outcomes while adjusting for patient characteristics and accounting for clustering of cases within hospitals. There were 118 448 infants 501 to 1500 g from 362 neonatal intensive care units enrolled in the Network Database from 1991 to 1999. Prenatal care, cesarean section, multiple births, antenatal steroids, and 1-minute Apgar scores increased during this period, as did the use of nasal continuous positive airway pressure, high-frequency ventilation, surfactant, and postnatal steroids. The proportion of white infants decreased; the proportions of Hispanic infants and those of other races increased. The crude and adjusted rates of mortality, pneumothorax, intraventricular hemorrhage (IVH), and severe IVH declined from 1991 to 1995, whereas from 1995 to 1999, the rates of mortality, IVH, and severe IVH did not change significantly, and pneumothorax increased. There have been major changes in both obstetric and neonatal care during the 1990s. These changes were associated with decreases in mortality and morbidity for VLBW infants during the first half of the decade. However, since 1995, no additional improvements in mortality or morbidity have been seen, ending a decades-long trend of improving outcomes for these infants.

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Author and article information

Contributors

Prakesh S Shah

Shoo K Lee

Kei Lui

Gunnar Sjörs

Rintaro Mori

Brian Reichman

Stellan Håkansson

Laura San Feliciano

Neena Modi

Mark Adams

Brian Darlow

Masanori Fujimura

Satoshi Kusuda

Ross Haslam

Lucia Mirea

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central

ISSN (Electronic): 1471-2431

Publication date Collection: 2014

Publication date (Electronic): 23 April 2014

Volume: 14

Page: 110

Affiliations

[1 ]Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, Ontario M5G 1X6, Canada

[2 ]Australia and New Zealand Neonatal Network, Royal Hospital for Women, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia

[3 ]Swedish Neonatal Quality Register, Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden

[4 ]Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan

[5 ]Israeli Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer 52621, Israel

[6 ]Swedish Neonatal Quality Register, Department of Pediatrics, Umea University Hospital, SE-901 85 Umeå, Sweden

[7 ]Spanish Neonatal Network, Unidad Neonatal Barakaldo, Plaza de cruces s/n, 5ª Planta, Unidad Neonatal, Barakaldo 48903, (Bizkaia), Spain

[8 ]UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London SW10 9NH, UK

[9 ]Swiss Neonatal Network, Division of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zürich, Switzerland

[10 ]Australia and New Zealand Neonatal Network, University of Otago, Christchurch, 2 Riccarton Avenue, PO Box 4345, Christchurch 8140, New Zealand

[11 ]Neonatal Research Network Japan, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan

[12 ]Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan

[13 ]Australia and New Zealand Neonatal Network, Women’s and Children’s Hospital, Adelaide, Level 2, McNevin Dickson Building, Sydney Children’s Hospital, Randwick, NSW 2031, Australia

Author notes

on behalf of the International Network for Evaluating Outcomes of Neonates (iNeo)

Article

Publisher ID: 1471-2431-14-110

DOI: 10.1186/1471-2431-14-110

PMC ID: 4021416

PubMed ID: 24758585

SO-VID: 4a7c82cf-b029-4824-90db-20331361fe97

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 25 February 2014

Date accepted : 5 March 2014

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Abstract

Background

Methods/design

Discussion

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 53

Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period.

CRIB II: an update of the clinical risk index for babies score.

Trends in mortality and morbidity for very low birth weight infants, 1991-1999.

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