Jehier Afifi

Objective To compare long-term outcomes of preterm infants in single-family room (SFR) vs. open-bay (OB) neonatal intensive care unit (NICU). Study design This randomized controlled trial took place in a tertiary NICU from April 2018 to June 2019. Infants p = 0.644). Secondary outcomes did not differ except mortality, which was lower in SFR (1/41, 2.4%) than OB (8/42, 19.0%), p = 0.029. Conclusions Composite outcome of death/NDI at 36 months corrected age was similar; however, reduction in mortality was noted in SFR. This trial was registered 6 Mar 2019 with ClinicalTrials.gov, NCT03867669 (https://clinicaltrials.gov/search?cond=NCT03867669).

We utilized antibiograms from 10 Canadian Neonatal Intensive Care Units to assess antimicrobial susceptibility patterns among Gram-negative bacilli during 2015–2021. Escherichia coli was the most prevalent isolate, with >85% susceptible to third-generation cephalosporin. The resistance to carbapenems was identified in <1% of the isolates.

Purpose: Is machine learning (ML) superior to the traditionally used logistic regression (LR) in prediction of neurodevelopmental outcomes in preterm infants? Objectives: To develop and internally validate a ML model to predict neurodevelopmental impairment (NDI) in very preterm infants (0–30⁶ weeks) born between January 2004 and December 2016 in Nova Scotia, Canada. Survivors with neurodevelopmental assessment at 36 months corrected age were included. The study sample was randomly split (80:20) into a development and testing datasets. We compared four methods: LR, elastic net (EN), random forest ensemble (RF) and gradient boosting (XGB), in relation to discrimination (AUC), calibration, and diagnostic properties. Results: Of 811 eligible infants, 663 were included (mean gestational age 28 weeks, mean birth weight 1137 g and 52% male). Of those, 195 (29%) developed NDI and 468 (71%) did not. On internal validation using the testing dataset, all four models provided good discrimination of NDI with comparable AUC. RF was superior to the other three methods with a higher AUC (0.79 vs. 0.74, 0.74, and 0.73 for XGB, EN and LR, respectively), but all models have overlapped CIs. Conclusions: In this population-based cohort of very preterm infants, RF was superior to conventional LR in prediction of NDI at 3 years corrected age. Accurate prediction of preterm infants at risk of NDI enables early referrals for intervention programs and resources allocation toward those who are most likely to benefit.

Objective Accurate and early prediction of neurodevelopmental impairment is a crucial endeavor in caring for very preterm infants (0–30⁶ weeks) born between January 2004 and December 2018 with a neurodevelopmental assessment at 36 months corrected age were included. Three prediction models of neurodevelopmental impairment were compared: 1. A reference model including the gestational age, infant sex, and 2-week and 6-week ultrasound 2. A model including the gestational age, infant sex, and 6-week ultrasound 3. A model including the gestational age, infant sex, and 2-week ultrasound Results Of 786 eligible preterm infants born during the study period, 656/786 survivors were included in the analysis (mean gestational age 27⁵ weeks, mean birth weight 1,133 g, and 55% male infants). At 36 months of corrected age, 30% developed neurodevelopmental impairment. All three models provided comparable discrimination areas under the curve (AUC) of neurodevelopmental impairment at 36 months of corrected age. Both the 6-week and the reference model had similar AUC of 0.68 (95% CI 0.63–0.72) and were not noticeably different from the 2-week model (AUC 0.66 (95% CI 0.61–0.70)). The 6-week model provided the best prediction with the lowest Akaike information criterion (AIC) of 766 for the 6-week-only model, AIC 769 for combined weeks 2 and 6 (reference model), and AIC 784 for the 2-week-only model. Conclusion In this cohort of very preterm infants, a model including 6-week ultrasound only was comparable to a reference model combining 2-week and 6-week ultrasound and showed nearly identical predictive performance of neurodevelopmental impairment at 36 months corrected age across a broad set of metrics; thus, it is redundant to do both the 2-week and 6-week ultrasound. Clinical relevance statement Late ultrasound at 6 weeks of age provided comparable diagnostic and prognostic information to a reference model combining 2-week and 6-week ultrasound and, if anything, was slightly superior to the 2-week ultrasound model, across a broad set of metrics. The 2-week ultrasound can be eliminated with no impact on the prediction of neurodevelopmental impairment at 36 months, promoting prudent resource allocation and stewardship in healthcare. Graphical Abstract

Neurodevelopmental challenges in children born very preterm are common and not improving. This study tested the feasibility of using Evidence-based Practice to Improve Quality (EPIQ), a proven quality improvement technique that incorporates scientific evidence to target improving language abilities in very preterm populations in 10 Canadian neonatal follow-up programs. Feasibility was defined as at least 70% of sites completing four intervention cycles and 75% of cycles meeting targeted aims. Systematic reviews were reviewed and performed, an online quality improvement educational tool was developed, multidisciplinary teams that included parents were created and trained, and sites provided virtual support to implement and audit locally at least four intervention cycles of approximately 6 months in duration. Eight of ten sites implemented at least four intervention cycles. Of the 48 cycles completed, audits showed 41 (85%) met their aim. Though COVID-19 was a barrier, parent involvement, champions, and institutional support facilitated success. EPIQ is a feasible quality improvement methodology to implement family-integrated evidence-informed interventions to support language interventions in neonatal follow-up programs. Further studies are required to identify potential benefits of service outcomes, patients, and families and to evaluate sustainability.

Objective: The aim of this study was to evaluate the neurodevelopmental outcome at 18–24 months in surviving preterm infants with grades I–IV intraventricular hemorrhages (IVHs) compared to those with no IVH. Study Design: We included preterm survivors <29 weeks’ GA admitted to the Canadian Neonatal Network’s NICUs from April 2009 to September 2011 with follow-up data at 18–24 months in a retrospective cohort study. The neonates were grouped based on the severity of the IVH detected on a cranial ultrasound scan and recorded in the database: no IVH; subependymal hemorrhage or IVH without ventricular dilation (grades I–II); IVH with ventricular dilation (grade III); and persistent parenchymal echogenicity/lucency (grade IV). The primary outcomes of neurodevelopmental impairment (NDI), significant neurodevelopmental impairment (sNDI), and the effect modification by other short-term neonatal morbidities were assessed. Using multivariable regression analysis, the adjusted ORs (AOR) and 95% of the CIs were calculated. Results: 2327 infants were included. The odds of NDI were higher in infants with grades III and IV IVHs (AOR 2.58, 95% CI 1.56, 4.28 and AOR 2.61, 95% CI 1.80, 3.80, respectively) compared to those without IVH. Infants with an IVH grade ≤II had similar outcomes for NDI (AOR 1.08, 95% CI 0.86, 1.35) compared to those without an IVH, but the odds of sNDI were higher (AOR 1.58, 95% CI 1.16, 2.17). Conclusions: There were increased odds of sNDI in infants with grades I–II IVHs, and an increased risk of adverse NDI in infants with grades ≥III IVHs is corroborated with the current literature.