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Do transport factors increase the risk of severe brain injury in outborn infants <33 weeks gestational age?

Journal of Perinatology volume 40, pages 385–393 (2020)Cite this article

Subjects

Abstract

Objective

We evaluated transport factors and postnatal practices to identify modifiable risk factors for SBI.

Study design

Retrospective review of Canadian Neonatal Transport Network data linked to Canadian Neonatal Network data for outborns <33 weeks gestational age (GA), during January 2014 to December 2015. SBI was defined as grade 3 or 4 intraventricular hemorrhage or parenchymal echogenicity, including hemorrhagic and/or ischemic lesions.

Result

Among 781 infants, 115 (14.7%) had SBI with range 5.6–40% among transport teams. In multivariable analysis, SBI was associated with GA [0.77 (0.71, 0.85)] per week, receipt of chest compressions and/or epinephrine at delivery [1.81 (1.08, 3.05)] and receipt of fluid boluses [1.61 (1.00, 2.58)].

Conclusions

Risk factors for SBI were related to the condition at birth and immediate postnatal management and not related to transport factors. These results highlight the importance of maternal transfer to perinatal centers to allow optimization of perinatal management.

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Site Investigators of the Canadian Neonatal Transport Network

Avash Singh and Joseph Ting, British Columbia Children’s & Women’s Hospital, Vancouver, British Columbia; Anne Tierney and Sumesh Thomas, Foothills Medical Centre and Alberta Children’s Hospital, Calgary, Alberta; Ernesto Phillips, Paul Byrne, and Jennifer Toye, Royal Alexandra Hospital and Stollery Children’s Hospital, Edmonton, Alberta; William Bingham and Sibasis Daspal, Royal University Hospital, Saskatoon Saskatchewan; Zarin Kalapesi, Regina General Hospital, Regina Saskatchewan; Rebecca Caces & Michael Narvey, Winnipeg Health Sciences Centre, Winnipeg Manitoba; Henry Roukema, London Health Sciences Centre, London, Ontario; Michael Marrin, McMaster Children’s Hospital, Hamilton, Ontario; Stephanie Redpath, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; Hilary Whyte, Hospital for Sick Children, Toronto, Ontario; Louis Beaumier and Thérèse Perrault, Montreal Children’s Hospital, Montreal Quebec; Geneviève Piuze, Centre Hospitalier Universitaire de Québec, Laval, Quebec; Edith Massé, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec; Krista Jangaard IWK Health Centre, Halifax, Nova Scotia; Akhil Desphpandey, Janeway Children’s Health & Rehabilitation Center, St. John’s, Newfoundland.

Site Investigators of the Canadian Neonatal Network

Jaideep Kanungo, MD, Victoria General Hospital, Victoria, British Columbia; Joseph Ting, MD, B.C. Women’s Hospital and Health Centre, Vancouver, British Columbia; Zenon Cieslak, MD, Royal Columbian Hospital, New Westminster, British Columbia; Rebecca Sherlock, MD, Surrey Memorial Hospital, Surrey, British Columbia; Ayman Abou Mehrem, MD, Foothills Medical Centre, Calgary, Alberta; Jennifer Toye, MD, Royal Alexandra Hospital, Edmonton, Alberta; Carlos Fajardo, MD, Alberta Children’s Hospital, Calgary, Alberta; Zarin Kalapesi, MD, and Jaya Bodani, MD, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, MD, MBBS, and Sibasis Daspal, MD, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, MBChB, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, MD, St. Boniface General Hospital, Winnipeg, Manitoba; Amit Mukerji, MD, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, MD, MSc, London Health Sciences Centre, London, Ontario; Chuks Nwaesei, MD, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, MD, MSc, Hospital for Sick Children, Toronto, Ontario; Michael Dunn, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Brigitte Lemyre, MD, Children’s Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; Faiza Khurshid, MD, Kingston General Hospital, Kingston, Ontario; Ermelinda Pelausa, MD, Jewish General Hospital, Montréal, Québec; Keith Barrington, MBChB, and Anie Lapoint, MD, Hôpital Sainte-Justine, Montréal, Québec; Christine Drolet, MD, and Bruno Piedboeuf, MD, Centre Hospitalier Universitaire de Québec, Sainte Foy, Québec; Martine Claveau, MSc, LLM, NNP, and Marc Beltempo, MD, Montreal Children’s Hospital at McGill University Health Centre, Montréal, Québec; Valerie Bertelle, MD, and Edith Masse, MD, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Roderick Canning, MD, Moncton Hospital, Moncton, New Brunswick; Hala Makary, MD, Dr. Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah, MBBS, and Luis Monterrosa, MD, Saint John Regional Hospital, Saint John, New Brunswick; Julie Emberley, MD, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland; Jehier Afifi, MB BCh, MSc, IWK Health Centre, Halifax, Nova Scotia; Andrzej Kajetanowicz, MD, Cape Breton Regional Hospital, Sydney, Nova Scotia.

Funding

This study was funded by a grant from the Canadian Institutes for Health. Research Partnerships in Health Service Improvement PHE 293626. This study was presented in part as a platform presentation at the American Academy of Pediatrics Section on Transport Medicine, Orlando Florida, USA in October 2018. This manuscript has not been published previously and is not under consideration elsewhere.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada

    Stephanie Redpath & Gregory P. Moore

  2. Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah

  3. MiCare, Toronto, ON, Canada

    Junmin Yang

  4. Stollery Children’s Hospital, Edmonton, AB, Canada

    Jennifer Toye

  5. Montreal Children’s Hospital—McGill University Health Centre, Montréal, QC, Canada

    Thérèse Perreault

  6. Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada

    Kyong-Soon Lee

Authors
  1. Stephanie Redpath
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  2. Prakesh S. Shah
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  5. Jennifer Toye
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Consortia

Canadian Neonatal Transport Network and Canadian Neonatal Network Investigators

Contributions

SR contributed to the conception and design, analysis and interpretation of data and drafted the article. PSS contributed to the analysis and interpretation of data and revised the article critically. GPM contributed to the analysis and interpretation of data and revised the article critically. JY contributed to the acquisition of data, analysis and interpretation of data, and revised the article critically. JT contributed to the analysis and interpretation of data and revised the article critically. TP contributed to the analysis and interpretation of data and revised the article critically. K-SL contributed to the conception and design, acquisition of data, analysis and interpretation of data, and revised the article critically. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Kyong-Soon Lee.

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The authors declare that they have no conflict of interest.

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Site investigators of the Canadian Neonatal Transport Network and Canadian Neonatal Network are listed at the end of the paper

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Redpath, S., Shah, P.S., Moore, G.P. et al. Do transport factors increase the risk of severe brain injury in outborn infants <33 weeks gestational age?. J Perinatol 40, 385–393 (2020). https://doi.org/10.1038/s41372-019-0447-1

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