Original Articles
Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units,☆☆,

Presented in part at the Annual Meeting of the Pediatric Academic societies, Boston, Mass, May 16, 2000.
https://doi.org/10.1067/mpd.2001.111822Get rights and content

Abstract

Objectives: To examine the variation in intraventricular hemorrhage (IVH) incidence among neonatal intensive care units and identify potentially modifiable risk factors. Study design: Multiple logistic regression analysis was used to examine variations in ≥grade 3 IVH, adjusting for baseline population risk factors, admission illness severity, and therapeutic risk factors. Subjects were born at <33 weeks’ gestational age, admitted within 4 days of life to 1 of 17 participating Canadian NICU network sites in 1996-97, and had neuroimaging in the first 2 weeks of life. Results: Of 5126 subjects <33 weeks’ gestational age, 3806 had neuroimaging reports. Five of 17 sites had significantly (P < .05) different crude incidence rates of grade 3-4 IVH (odds ratios [OR] 0.2, 3.2, 2.6, 2.1, 1.9) than the hospital with median incidence. With adjustment for baseline population risk factors, perinatal risks, and admission illness severity, IVH incidence rates remained significantly (P < .05) higher at 3 sites (OR 2.9, 2.3 and 2.1). Inclusion of therapy-related variables (treatment of acidosis and vasopressor use on the day of admission) in the model eliminated all site differences. Conclusions: IVH incidence rates vary significantly. Patient characteristics explain some of the variance. Early treatment of hypotension and acidosis and mode of delivery are potentially modifiable factors and warrant further study in IVH prevention. (J Pediatr 2001;138:525-31)

Section snippets

Population

The study population comprised all 19,507 infants admitted to 17 NICUs in the Canadian NICU Network from January 8, 1996, to October 31, 1997. The 17 hospitals, except one, are regional tertiary level referral centers and include 75% of level 3 NICU beds in Canada. The NICUs ranged in size from 9 to 70 beds and had an average of 133 to 1129 admissions annually. The data were collected as part of a larger study of practices and outcomes of NICUs1 across Canada, which had a population of nearly

Results

Of the 19,507 infants admitted to the Canadian NICU Network during the study period, 5126 were <33 completed weeks’ GA at birth and <4 days old at admission. Of these infants, 3806 had neuroimaging performed in the first 2 weeks of life. Neuroimaging reports were available for 89% of all infants <31 weeks’ GA and 58% of all infants between 31 and 32 weeks’ GA. Neuroimaging practices differed significantly between NICUs (range, 63%-100% among infants <33 weeks’ GA). Infants with neuroimaging

Discussion

This study demonstrates a statistically and clinically significant variation in the incidence of diagnosed IVH in premature infants (<33 weeks’ GA) admitted to NICUs. This variation existed across all grades of IVH and all GA categories. Previous reports of variations in the incidence of diagnosed IVH among preterm infants admitted to NICUs did not adjust for variations in patient population. In our study, we found that risk adjustment for baseline population risk factors and SNAP-II resulted

Acknowledgements

Members of the Canadian NICU Network: Shoo K. Lee, MBBS, FRCPC, PhD (Coordinator, Canadian NICU Network; Centre for Community Health and Health Evaluation Research, Vancouver, BC); Wayne Andrews, MD, FRCPC (Charles A. Janeway Child Health Centre, St John’s, NF); Ranjit Baboolal, MBChB, FRCPC (North York Hospital, North York, ON); Jill Boulton, MD, FRCPC (St Joseph’s Health Centre, London, ON; previously Mt Sinai Hospital, Toronto, ON); David Brabyn, MBChB, FRACP, FRCPC (Royal Columbian

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    A complete list of the members of the Canadian NICU Network appears at the end of this article

    ☆☆

    Supported by Grant 40503 and Grant 00152 from the Medical Research Council of Canada. Additional funding was provided by the B.C.’s Children’s Hospital Foundation; Calgary Regional Health Authority; Dalhousie University Neonatal-Perinatal Research Fund; Division of Neonatology, Children’s Hospital of Eastern Ontario; Child Health Program, Health Care Corporation of St John’s; The Neonatology Program, Hospital for Sick Children; Lawson Research Institute; Midland Walwyn Capital Inc; Division of Neonatology, Hamilton Health Sciences Corporation; Mount Sinai Hospital; North York General Hospital Foundation; Saint Joseph’s Health Centre; University of Saskatchewan Neonatal Research Fund; and University of Western Ontario; Women’s College Hospital.

    Reprint requests: Shoo K. Lee, MBBS, FRCPC, PhD, Centre for Community Health and Health Evaluation Research, 4480 Oak St, Room E-414, Vancouver, BC, V6H 3V4 Canada.

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