Neonatal Intensive Care Unit Outcomes of Very Preterm Infants in Australia, New Zealand and Canada

Abstract

Very preterm infants, born less than 32 weeks gestation, have a high rate of in-hospital mortality and both short term and long term morbidities. A rising rate of preterm births worldwide means outcome improvement of these vulnerable infants is a healthcare priority. International comparison and benchmarking of NICU outcomes between high achieving countries can set standards for very preterm care and evaluate effects of quality–improvement initiatives. The aim of this thesis was to provide a comprehensive comparison of NICU outcomes of very preterm infants born in Australia-New Zealand and Canada, for benchmarking purpose. We utilised data from the Australian and New Zealand Neonatal Network (ANZNN) and Canadian Neonatal Network (CNN) to investigate the research questions. Study 1 was an overview of ANZNN and CNN. Despite demographic and healthcare system similarities between Canada and Australia and New Zealand, very premature infants admitted to the ANZNN after adjustment for confounding variables were 30% less likely to develop severe neurological injury (SNI), retinopathy of prematurity (ROP), necrotising enterocolitis (NEC) or chronic lung disease (CLD). Study 2 was an outcome comparison of inborn and outborn infants as defined by births in tertiary perinatal units. ANZNN had fewer outborns and lower morbidity rates in both inborn and outborn population than CNN. CNN outborn infants admitted from Level II units were more likely to be admitted later possibly due to subsequent surgical needs. CNN outborns after risk adjustments did not have less favourable outcomes, while CNN inborn had more major neonatal morbidities when compared with ANZNN counterparts. Study 3 was designed to investigate any change in NICU outcomes in ANZNN and CNN over 6 years. We found, even though ANZNN continued to have better outcomes, CNN had significant improvements in SNI and ROP rates but there was no change in these measures in ANZNN. In the 6 years of risk adjusted outcomes, ANZNN infants had an increase in both CLD and composite adverse outcome rates while CNN infants had a decrease. We suggest the more evident outcome improvement trends in CNN may be a result of their EPIQ initiatives. In conclusion, we found better outcomes in Australia–New Zealand along with indications of a more regionalised very preterm care in this region. However, we found CNN NICU outcomes are improving at a greater rate than ANZNN. We postulate the proactive quality–improvement initiatives in CNN may have been the primary reason of the improved outcomes in CNN. Furthermore, we propose that the overall better outcomes in ANZNN could similarly be improved. Greater international collaborative and benchmarking initiatives may lead to outcome improvements worldwide.