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Project 27/28: Inquiry into quality of neonatal care and its effect on the survival of infants who were born at 27 and 28 weeks in England, Wales and Northern Ireland

Project 27/28: Inquiry into quality of neonatal care and its effect on the survival of infants who were born at 27 and 28 weeks in England, Wales and Northern Ireland
Project 27/28: Inquiry into quality of neonatal care and its effect on the survival of infants who were born at 27 and 28 weeks in England, Wales and Northern Ireland
Objective: to identify variations in standards of neonatal care in the first week of life that might have contributed to deaths in infants who were born at 27 and 28 weeks' gestation.

Methods: acase-control study was conducted of infants who were born at 27 and 28 weeks' gestation in England, Wales, and Northern Ireland during a 2-year period. Cases were neonatal deaths; control subjects were randomly selected survivors at day 28. Main outcome measures were failures of prespecified standards of care or deficiencies in care reported by regional panels assessing anonymized medical records.

Results: failures of standards of care relating to ventilatory support (adjusted odds ratio [OR]: 3.29; 95% confidence interval [CI]: 1.97–5.49), cardiovascular support (OR: 2.37; 95% CI :1.36–4.13), and thermal care (OR: 1.71; 95% CI: 1.21–2.43) were associated with neonatal death. Frequencies of unmet resuscitation standards (range: 3%–46%) and of delays in surfactant administration (range: 38%–40%) were similar in cases and control subjects. Panels identified significantly more deficiencies in all aspects of neonatal care in cases with the exception of the management of infection. Stratification by clinical condition of infants at birth showed a stronger association between overall standard of care and death when infants were in a good condition at birth.

Conclusions: our findings suggest an association between quality of neonatal care and neonatal deaths, most marked for early thermal care and ventilatory and cardiovascular support. Poor overall quality of care was more strongly associated with deaths when the infant was in a good condition at birth
epidemiology, neonatology
1876-2859
1457-1465
Acolet, D.
b7fa539b-6a53-4679-8ba5-5979f72fdb49
Elbourne, D.
8e9139bd-ea96-44d3-b05e-5a59959f2024
McIntosh, N.
70e8a9bb-1837-4d3e-9795-b3e81610779a
Weindling, M.
76b4dc1c-5e9d-4894-8e2d-29e9e381647e
Korkodilos, M.
a417ae92-5842-4abf-9055-46caec427790
Haviland, J.S.
569aa43b-15bd-4e9d-b4a5-e68a84334cfe
Modder, J.
773bfda8-5ba6-48f2-b3c3-8c2bbe34a88e
Macintosh, M.
8e18c88f-6f4f-4c35-bfda-27b4a05b6a22
Acolet, D.
b7fa539b-6a53-4679-8ba5-5979f72fdb49
Elbourne, D.
8e9139bd-ea96-44d3-b05e-5a59959f2024
McIntosh, N.
70e8a9bb-1837-4d3e-9795-b3e81610779a
Weindling, M.
76b4dc1c-5e9d-4894-8e2d-29e9e381647e
Korkodilos, M.
a417ae92-5842-4abf-9055-46caec427790
Haviland, J.S.
569aa43b-15bd-4e9d-b4a5-e68a84334cfe
Modder, J.
773bfda8-5ba6-48f2-b3c3-8c2bbe34a88e
Macintosh, M.
8e18c88f-6f4f-4c35-bfda-27b4a05b6a22

Acolet, D., Elbourne, D., McIntosh, N., Weindling, M., Korkodilos, M., Haviland, J.S., Modder, J. and Macintosh, M. (2005) Project 27/28: Inquiry into quality of neonatal care and its effect on the survival of infants who were born at 27 and 28 weeks in England, Wales and Northern Ireland. Academic Pediatrics, 116 (6), 1457-1465. (PMID:16322171)

Record type: Article

Abstract

Objective: to identify variations in standards of neonatal care in the first week of life that might have contributed to deaths in infants who were born at 27 and 28 weeks' gestation.

Methods: acase-control study was conducted of infants who were born at 27 and 28 weeks' gestation in England, Wales, and Northern Ireland during a 2-year period. Cases were neonatal deaths; control subjects were randomly selected survivors at day 28. Main outcome measures were failures of prespecified standards of care or deficiencies in care reported by regional panels assessing anonymized medical records.

Results: failures of standards of care relating to ventilatory support (adjusted odds ratio [OR]: 3.29; 95% confidence interval [CI]: 1.97–5.49), cardiovascular support (OR: 2.37; 95% CI :1.36–4.13), and thermal care (OR: 1.71; 95% CI: 1.21–2.43) were associated with neonatal death. Frequencies of unmet resuscitation standards (range: 3%–46%) and of delays in surfactant administration (range: 38%–40%) were similar in cases and control subjects. Panels identified significantly more deficiencies in all aspects of neonatal care in cases with the exception of the management of infection. Stratification by clinical condition of infants at birth showed a stronger association between overall standard of care and death when infants were in a good condition at birth.

Conclusions: our findings suggest an association between quality of neonatal care and neonatal deaths, most marked for early thermal care and ventilatory and cardiovascular support. Poor overall quality of care was more strongly associated with deaths when the infant was in a good condition at birth

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More information

Published date: 2005
Keywords: epidemiology, neonatology
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 365439
URI: https://eprints.soton.ac.uk/id/eprint/365439
ISSN: 1876-2859
PURE UUID: bd89b7eb-00b5-40f1-a08c-b56099a6b64b

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Date deposited: 06 Jun 2014 07:56
Last modified: 30 Sep 2017 05:53

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Contributors

Author: D. Acolet
Author: D. Elbourne
Author: N. McIntosh
Author: M. Weindling
Author: M. Korkodilos
Author: J.S. Haviland
Author: J. Modder
Author: M. Macintosh

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