Search

Purpose Program evaluation stands as an evidence-based process that would allow institutions to document and improve the quality of graduate programs and determine how to respond to growing calls for aligning training models to economic realities. This paper aims to present the current state of evaluation in research-based doctoral programs in STEM fields. Design/methodology/approach To highlight the recent evaluative processes, the authors restricted the initial literature search to papers published in English between 2008 and 2019. As the authors were motivated by the shift at NIH, this review focuses on STEM programs, though papers on broader evaluation efforts were included as long as STEM-specific results could be identified. In total, 137 papers were included in the final review. Findings Only nine papers presented an evaluation of a full program. Instead, papers focused on evaluating individual components of a graduate program, testing small interventions or examining existing national data sets. The review did not find any documents that focused on the continual monitoring of training quality. Originality/value This review can serve as a resource, encourage transparency and provide motivation for faculty and administrators to gather and use assessment data to improve training models. By understanding how existing evaluations are conducted and implemented, administrators can apply evidence-based methodologies to ensure the highest quality training to best prepare students.

Many biological science PhD graduates are increasingly pursuing careers outside of academia. Subsequently, PhD training programs are increasing their efforts to broaden their awareness of diverse career opportunities, with a firm knowledge of the skills necessary for success. At Yale University, for two semesters we have offered a new course for graduate students in the biological sciences titled “Skills Development for Diverse Scientific Careers” (BBS 550b). This course addressed career‐related topics not covered in any curriculum at Yale such as how to run clinical trials, the business side of biotech, how to convert CVs into resumes, and resilience for early career scientists. We sought to better equip students to think broadly about their career options by exposing them to non‐academic biomedical career avenues. Furthermore, the course fulfilled a gap in current curricular offerings to prepare students for multiple science career trajectories. Results on a pre‐post course survey demonstrated increases in students’ interest for, knowledge of, and confidence in securing a position in multiple nontraditional career sectors. Intentional course design can provide an adequate foundation to broaden awareness of myriad career options available to bioscientists. Broadening student knowledge and interest levels will contribute substantially to developing a robust scientific workforce.

Background Children with complex medical needs (CMN) are high healthcare resource utilizers, have varying underlying diagnoses, and experience repeated hospitalizations. Outcomes on neonatal intensive care (NICU) patients with CMN are unknown. Purpose The primary aim is to describe the clinical profile, resource use, prevalence, and both in-hospital and postdischarge outcomes of neonates with CMN. The secondary aim is to assess the feasibility of sustaining the use of the neonatal complex care team (NCCT). Methods A retrospective cohort study was conducted after implementing a new model of care for neonates with CMN in the NICU. All neonates born between January 2013 and December 2016 and who met the criteria for CMN and were cared for by the NCCT were included. Results One hundred forty-seven neonates with a mean (standard deviation) gestational age of 34 (5) weeks were included. The major underlying diagnoses were genetic/chromosomal abnormalities (48%), extreme prematurity (26%), neurological abnormality (12%), and congenital anomalies (11%). Interventions received included mechanical ventilation (69%), parenteral nutrition (68%), and technology dependency at discharge (91%). Mortality was 3% before discharge and 17% after discharge. Postdischarge hospital attendances included emergency department visits (44%) and inpatient admissions (58%), which involved pediatric intensive care unit admissions (26%). Implications for practice Neonates with CMN have multiple comorbidities, high resource needs, significant postdischarge mortality, and rehospitalization rates. These cohorts of NICU patients can be identified early during their NICU course and serve as targets for implementing innovative care models to meet their unique needs. Implications for research Future studies should explore the feasibility of implementing innovative care models and their potential impact on patient outcomes and cost-effectiveness.

Courses that teach evidence-based interventions to enhance well-being are a public health tool that could be used to improve mental health in the population. We compared the well-being of six cohorts of adult students before and after they completed one of two massive open online courses: The Science of Well-Being (N = 581; 441; 1,228) and a control course, Introduction to Psychology (N = 677; 480; 1,480). Baseline well-being levels were equivalent across all six samples. Students in both courses increased in their well-being from baseline to follow-up in all three samples (p < .001); however, at follow-up, students in The Science of Well-Being course had higher subjective well-being than the control course (sample 1: r = .18, d = .37, p < .001; sample 2: r = .21, d = .43, p < .001; sample 3: r = .19, d = .38, p < .001). Overall, across three samples, we found that students who completed either of these online psychology courses increased in their well-being––but that students in The Science of Well-Being course showed greater improvement. These findings suggest that large free online courses that teach evidence-based approaches to well-being could positively impact mental health at large scales.

Background It has been hypothesized that 4 doses of palivizumab, a neutralizing monoclonal antibody against respiratory syncytial virus (RSV), administered during a fixed-date RSV season may reduce hospital admissions comparably to the standard 5-dose schedule. We report outcomes in children with congenital heart disease approved to receive this 4-dose palivizumab schedule in British Columbia. Methods We performed a population-based descriptive cohort analysis of all 406 approved palivizumab courses over 4 seasons (2012/13 to 2015/16) in 325 children with hemodynamically significant congenital heart disease enrolled in the British Columbia RSV Immunoprophylaxis Program. The primary outcome was in-season hospital admission for potential RSV-related lower respiratory tract infection (LRTI). Secondary outcomes include timing of admission in relation to dosing. Analysis was by intention-to-treat. Results Of the 406 approved palivizumab courses, 391 were administered. In 33 cases (8.4%), an additional dose was given immediately after cardiac bypass surgery. There were 17 RSV-confirmed hospital admissions (median age of children 5.9 mo [interquartile range 4-10 mo]) and 8 admissions in which the child was not tested for RSV, for a maximum of 25 potential RSV-related admissions (6.2 per 100 approvals [95% confidence interval 4.0-9.0]). Twenty-four (96%) of the 25 admissions occurred within the 4-dose palivizumab dosing period, and the remaining admission occurred 52 days after the fourth dose. Sixty-four (72%) of 89 admissions were RSV-negative; the baseline clinical characteristics of these children were not different from those of children with RSV-confirmed admissions. Interpretation In infants with hemodynamically significant congenital heart disease, a 4-dose fixed-date palivizumab schedule over a 6-month season provided seasonal protection comparable to that in a clinical trial involving a standard 5-dose schedule. Because RSV was responsible for only 19% of admissions for LRTI in our cohort, it is critical to continue to emphasize other preventive measures, including family education toward proper hand hygiene, breast-feeding and limiting infectious exposures in children at high risk.

Despite evidence suggesting that parent involvement was beneficial for infant and parent outcomes, the Family Integrated Care (FICare) programme was one of the first pragmatic approaches to enable parents to become primary caregivers in the neonatal intensive care unit (NICU). We aimed to analyse the effect of FICare on infant and parent outcomes, safety, and resource use.In this multicentre, cluster-randomised controlled trial, we stratified 26 tertiary NICUs from Canada, Australia, and New Zealand by country and size, and assigned them, using a computer-generated random allocation sequence, to provide FICare or standard NICU care. Eligible infants were born at 33 weeks' gestation or earlier, and had no or low-level respiratory support; parents gave written informed consent for enrolment. To be eligible, parents in the FICare group had to commit to be present for at least 6 h a day, attend educational sessions, and actively care for their infant. The primary outcome, analysed at the individual level, was infant weight gain at day 21 after enrolment. Secondary outcomes were weight gain velocity, high frequency breastfeeding (≥6 times a day) at hospital discharge, parental stress and anxiety at enrolment and day 21, NICU mortality and major neonatal morbidities, safety, and resource use (including duration of oxygen therapy and hospital stay). This trial is registered with ClinicalTrials.gov, number NCT01852695.From Oct 1, 2012, 26 sites were randomly assigned to provide FICare (n=14) or standard care (n=12). One site assigned to FICare discontinued because of poor site enrolment. Parents and infants were enrolled between April 1, 2013, and Aug 31, 2015, with 895 infants being eligible in the FICare group and 891 in the standard care group. At day 21, weight gain was greater in the FICare group than in the standard care group (mean change in Z scores -0·071 [SD 0·42] vs -0·155 [0·42]; p0·0002). Average daily weight gain was significantly higher in infants receiving FICare than those receiving standard care (mean daily weight gain 26·7 g [SD 9·4] vs 24·8 g [9·5]; p0·0001). The high-frequency exclusive breastmilk feeding rate at discharge was higher for infants in the FICare group (279 [70%] of 396) than those in the standard care group (394 [63%] of 624; p=0·016). At day 21, parents in the FICare group had lower mean stress scores than did parents in the standard care group (2·3 [SD 0·8] vs 2·5 [0·8]; p0·00043), and lower mean anxiety scores (70·8 [20·1] vs 74·2 [19·9]; p=0·0045). There were no significant differences between groups in the rates of the secondary outcomes of mortality, major morbidity, duration of oxygen therapy, and duration of hospital stay. Although the safety assessment was not completed, there were no adverse events.FICare improved infant weight gain, decreased parent stress and anxiety, and increased high-frequency exclusive breastmilk feeding at discharge, which together suggest that FICare is an important advancement in neonatal care. Further research is required to examine if these results translate into better long-term outcomes for families.Canadian Institutes of Health Research Partnerships for Health System Improvement, and Ontario Ministry of Health and Long-Term Care.

Conducting collaborative and comprehensive epidemiological research on neonatal sepsis in low- and middle-income countries (LMICs) is challenging due to a lack of diagnostic tests. This prospective study protocol aims to obtain epidemiological data on bacterial sepsis in newborns and young infants at Kamuzu Central Hospital in Lilongwe, Malawi. The main goal is to determine if the use of whole blood transcriptome host immune response signatures can help in the identification of infants who have sepsis of bacterial causes. The protocol includes a detailed clinical assessment with vital sign measurements, strict aseptic blood culture protocol with state-of-the-art microbial analyses and RNA-sequencing and metagenomics evaluations of host responses and pathogens, respectively. We also discuss the directions of a brief analysis plan for RNA sequencing data. This study will provide robust epidemiological data for sepsis in neonates and young infants in a setting where sepsis confers an inordinate burden of disease.

Conducting collaborative and comprehensive epidemiological research on neonatal sepsis in low- and middle-income countries (LMICs) is challenging due to a lack of diagnostic tests. This prospective study protocol aims to obtain epidemiological data on bacterial sepsis in newborns and young infants at Kamuzu Central Hospital in Lilongwe, Malawi. The main goal is to determine if the use of whole blood transcriptome host immune response signatures can help in the identification of infants who have sepsis of bacterial causes. The protocol includes a detailed clinical assessment with vital sign measurements, strict aseptic blood culture protocol with state-of-the-art microbial analyses and RNA-sequencing and metagenomics evaluations of host responses and pathogens, respectively. We also discuss the directions of a brief analysis plan for RNA sequencing data. This study will provide robust epidemiological data for sepsis in neonates and young infants in a setting where sepsis confers an inordinate burden of disease.

BACKGROUND: Respiratory Syncytial Virus (RSV) is a leading cause of hospital admission for acute lower respiratory tract infections (LRTI) in young children. Infants with congenital heart disease (CHD) are at a higher risk of severe infection, specifically those with hemodynamically significant intra-cardiac shunts, impaired cardiac function or pulmonary hypertension. Palivizumab prevents RSV-related hospitalizations in children with higher risk indications, including CHD, however the number of doses required to achieve optimal protection remains controversial. We report the clinical outcomes of children with CHD who received an abbreviated Palivizumab 4-dose schedule, with an increased inter-dose interval in our region. OBJECTIVES: To report hospitalization outcomes in children with CHD who received an abbreviated 4-dose Palivizumab dose schedule through the centrally managed regional RSV Immunoprophylaxis Program. DESIGN/METHODS: Retrospective population-based study of children with CHD enrolled into the regional RSV Program between 2012–2016. Children received palivizumab between November and April. Eligibility was defined according to our provincial guidelines and this defined our sample size. The primary outcome was in-season hospitalizations for RSV-confirmed or potentially RSV-related (unknown) LRTI determined by cross referencing the RSV Program database and the Canadian Institute of Health Informatics (CIHI) discharge abstract database (DAD) using seven RSV-related ICD-10 diagnostic codes. Children were categorized according to CHD subtype. Analysis was by intention-to-treat. RESULTS: A total of 325 children ([mean ± SD] gestational age 37.9±6.2 weeks; birth weight 2870±871 grams) were approved to receive 406 palivizumab courses. Between November 2012 and April 2016, 89 hospitalizations occurred in CHD patients. Of this, seventeen were RSV-confirmed hospitalizations (median age 5.9 [IQR 4 to 10]months); 8 additional cases were not tested for RSV, for a maximum rate of hospitalizationsfor RSV-confirmed or unknown of 6.2 per 100 approvals (95%CI: 4.0 to 9.0%). 24/25 RSV-confirmed or potentially RSV-related hospitalizations occurred before the 4(th)Palivizumab dose. Only one RSV-confirmed hospitalization occurred (52 days) after the 4th Palivizumab dose. Clinical characteristics of children with RSV-confirmed hospitalizations (n=17) were similar to those with RSV-unrelated hospitalizations (n=40). CONCLUSION: Our data provide population-based evidence of the protection achieved by a 4-dose Palivizumab dose schedule in infants with CHD. This clinical practice yields substantial benefits to children, their families, and to the health care system, such as reduced visits, injections, and costs, compared to a standard 5-dose schedule. Our results warrant confirmation in other geographic areas.

BACKGROUND: RSV prophylaxis with palivizumab is restricted to evidence-based indications in infants at relatively higher hospital admission risk. The RSV Program’s criteria follow CPS and AAP guidelines, but adjudication is needed in conditions of questionable efficacy or in infants who have a moderate risk of contracting RSV. In 2015–16, a blinded simple-majority Panel-of-Three adjudication (PoTA) process was implemented where adjudicators are from different specialities (e.g. neonatology, Peds ID, etc.) and are neither caregivers nor have funding that can be traced to the manufacturer/vendor for conflict of interest (COI) and bias avoidance. OBJECTIVES: To review adjudications across 3 RSV seasons (2015–2018) and determine the benefits and challenges associated with the PoTA structure. DESIGN/METHODS: All cases of PoTAs were reviewed and categorized based on age of infant, season, and diagnosis. Seasonal admissions with RSV & LRTI were ascertained provincially using 7 RSV-related acute respiratory infection ICD-10 codes, and cross-checked using the Program’s palivizumab database. The reliability of agreement within PoTAs during each season was measured with average pairwise percent agreement (APPA) and Fleiss kappa. RESULTS: In the 2015–16, 2016–17, and 2018-18 seasons, 67/467 applications (14.2%), 64/416 (15.4%), and 64/452 (13.9%) were adjudicated, with overall approval rates of 51%, 42% and 33% respectively. There was a trend towards lower approval rates from 2015–16 (range: 42–60%) to 2017–18 (25–38%), with a median approval turnaround time of 3 days. Infants with “exceptional conditions” (e.g. progressive neuromuscular and central nervous system disorders) comprised the largest category of applicants undergoing PoTA, followed by infants with significant pulmonary disabilities. Infants with immunodeficiencies were consistently approved in >80% of cases. In 2015–16, 2016–17 and 2017–18, the APPA and Fleiss kappa were found to be 78.1% and 0.57, 76.0% and 0.51 (moderate agreements) and 83.3% and 0.63 (moderate-to-substantial agreement). Unanimous decisions were reached in 46%, 47%, and 48% of cases amongst 3 adjudicators, for each season, respectively. Hospitalization rates were 20/82 (5 RSV+) in approved, and 3/113 (2 RSV+) in non-approved cases over 3 seasons. CONCLUSION: We describe an adjudication process that balances transparency and independence of adjudicators from one another. Timely decisions were reached in most cases, and the rates of hospitalized infants in the non-approved category remained small. The PoTA reached agreement in the adjudication decision in most cases and the low hospitalization rates in non-approved infants suggest that the decision process is both safe and efficient.

BACKGROUND: RSV palivizumab prophylaxis remains controversial in infants 29-34w GA without bronchopulmonary dysplasia (BPD). In our RSV Program these infants only qualify if they cumulate risk factors (e.g. # siblings, breastfeeding, smoking at home, daycare attendance, etc.; for risk score>42 pts) and their date of discharge is after Oct01. This risk score was developed from the literature (including FLIP and PICNIC studies) and has been in use since 2013. We track all seasonal RSV=related admissions in infants ≤24 months. OBJECTIVES: To compare RSV-related hospitalizations between infants who exceeded the risk threshold versus those who did not, across 4 RSV seasons. DESIGN/METHODS: The RSV season runs from Nov01 to Apr30, so by definition all first season infants are 42 pts; Group 2: infants 29-34w, age ≤2 months with a risk score ≤42 pts; Group 3: infants 29-34w, age 2–6 months with a risk score ≤42 pts. RSV-related admissions were obtained by linking 3 databases: Discharge Abstract Database using 7 RSV-related ICD-10 diagnostic codes, Perinatal Services regional Perinatal Data Registry (to establish the gestational age of infants), and RSV Program database. RESULTS: Only 355/2652 (13.3%) of infants 29-34w were admitted into the Program. Despite prophylaxis, Group 1 infants had higher RSV-related hospitalization rates than infants in Group 2. In subgroup analysis, infants born 29-32w were at increased risk in Groups 1 and 3, whereas infants 29-32w in Group 2 were not at increased risk, compared to infants 33–34 weeks (by 95% confidence intervals – not shown). Table shows proportions of RSV-related admissions with p-values defined between groups. CONCLUSION: The regional risk score safely and effectively selects the 13% of 29 to 34w infants ≤2mo with a high risk of RSV-related hospitalizations. [Image: see text]

Background Monthly injections of palivizumab during the respiratory syncytial virus (RSV) season in at-risk infants reduces RSV-associated hospitalizations. However, the additive effect of naturally acquired immunity remains unclear. The objective of this study was to assess total neutralizing serum antibodies (NAb) against RSV in at-risk infants who had received an abbreviated course of palivizumab prophylaxis. Methods Serum samples were collected from infants enrolled in the RSV Immunoprophylaxis Program in British Columbia, Canada over 2 consecutive RSV seasons (2013 to 2015). Infants in this program had received an abbreviated course of palivizumab in accordance with the provincial guidelines. Data were compared to adults and infants less than 12 months of age who did not receive palivizumab. Anti-RSV NAb titers were measured using an RSV microneutralization assay. Findings Infants who received palivizumab had anti-RSV NAb titers at the end of the RSV season that persisted beyond what is expected from the pharmacokinetics of palivizumab alone. Moreover, 54% of the control infants who did not receive palivizumab and all tested adults had protective anti-RSV NAb titers. Conclusions Based on our observations, we hypothesize that naturally acquired NAb provide additive protection, which may significantly reduce the need for additional doses of palivizumab in infants at risk of severe RSV infections.

Introduction: Despite similarities, perinatal and infant mortality rates between British Columbia, (BC) Canada and Finland differ. Key variables that may influence stillbirth, early neonatal, perinatal and infant mortality rates in BC and Finland were studied. Methods: After standardizing definitions, data for all births between 2001 and 2009 from provincial and national registries were used to compare perinatal outcomes between BC and Finland. Annual change was evaluated with regression analyses. Results: Births before 22 weeks gestation were excluded. All mortality rates per 1000 were lower in Finland vs BC (perinatal: 5.1 vs 6.2, stillbirth: 3.4 vs 3.9, early neonatal 1.7 vs 2.4, infant 2.9 vs 4.0; all p Higher multiple birth and preterm birth rates in BC are affecting mortality rates. Finland’s policy of single embryo transfer is a potential explanation. It is possible to have good perinatal outcomes and low caesarean section rates. Conclusions: The Finnish health care system may suggest possible solutions for improved perinatal outcomes. Lower per capita health care expenditures in Finland do not appear to have adversely affected perinatal outcomes.

Perinatal care of infants with congenital diaphragmatic hernia (CDH) is nonstandardized and costly. We examined a risk-adjusted cohort of patients with CDH and hypothesized that (1) among CDH survivors, the cost of the birth admission would be proportional to illness severity, and (2) this cost would be significantly higher compared with a matched non-CDH cohort.A retrospective review of costs and outcomes for all patients with CDH admitted to British Columbia Children's Hospital between 1999 and 2003 was performed. Risk grouping of patients with CDH using a validated admission severity score (Score for Neonatal Acute Physiology-version II [SNAP-II]) was conducted, enabling comparison among infants surviving to discharge. Hospital costs were also compared with a contemporaneous, non-CDH cohort matched for birth weight and SNAP-II.Thirty-two infants with CDH were included, of who 5 required extracorporeal membrane oxygenation. Twenty-three (72%) infants survived to discharge, with an average length of stay of 46 days. Average cost per survivor to discharge was 54,102 dollars (vs 13,722 dollars for the non-CDH cohort; P.05). After SNAP-II stratification of survivors into low-, moderate-, and high-risk groups, a significant cost difference was noted between the moderate- and low-risk and high- and low-risk groups, respectively.Infants born with CDH require costly care and can be expected to consume disproportionate resources. Admission SNAP-II score correlates with total cost to discharge. Risk stratification and cost comparison of larger CDH populations may allow identification of cost-efficient treatment strategies.

To describe the outcomes of gastroschisis (GS) patients managed with and without a multidisciplinary team during the postoperative period in Canada.The Canadian Pediatric Surgery Network (CAPSNet) collects patient data from all Canadian tertiary perinatal centres. The outcomes of 396 GS patients born between 2005 and 2009 who were managed with and without a multidisciplinary team were analyzed.Significantly more parenteral nutrition (PN) days (P=0.003) and longer lengths of stay (P=0.018) were observed among patients in centres with multidisciplinary teams. Higher mortality rate and earlier death were observed in centres without multidisciplinary teams, especially for high-risk patients, although this was not statistically significant. With regard to low-risk patients, those in centres with multidisciplinary teams had significantly more PN days (P=0.019).GS patients managed by multidisciplinary teams had significantly more PN days and longer lengths of stay compared with patients who were not managed by multidisciplinary teams. This difference may be due to improved survival of high-risk patients in centres with multidisciplinary teams, and a uniform feeding approach for all patients.Décrire l’évolution des patients ayant un gastroschisis (GS) traités ou non par une équipe multidisciplinaire pendant la période postopératoire au Canada.Le Réseau canadien de chirurgie pédiatrique (CAPSNet) collige les données sur les patients de tous les centres périnatals de soins tertiaires au Canada. L’évolution de 396 patients ayant un GS nés entre 2005 et 2009 et qui ont été traités ou non par une équipe multidisciplinaire a été analysée.Les patients hospitalisés dans des centres dotés d’équipes multidisciplinaires passaient considérablement plus de jours sur alimentation parentérale (AP) (P=0,003) et étaient hospitalisés plus longtemps (P=0,018). Bien que ce résultat ne soit pas significatif, le taux de mortalité était plus élevé et les décès, plus rapides dans les centres ne disposant pas d’une équipe multidisciplinaire, surtout chez les patients à haut risque. Pour ce qui est des patients à faible risque, ceux qui étaient traités dans des centres disposant d’une équipe multidisciplinaire passaient considérablement plus de jours sur AP (P=0,019).Les patients ayant un GS traités par une équipe multidisciplinaire passaient considérablement plus de jours sur AP et étaient hospitalisés plus longtemps que ceux qui n’étaient pas traités par une telle équipe. Cette différence peut être attribuable au meilleur taux de survie des patients à haut risque dans les centres disposant d’équipes multidisciplinaires et à une approche uniforme en matière d’alimentation pour tous les patients.

Background The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks’ gestation. Objective To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. Methods We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. Results PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. Conclusion Construction of a separate CPN database was needed, although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.

Purpose Outcomes studies for gastroschisis are constrained by small numbers, prolonged accrual, and nonstandardized data collection. The aim of this study is to create a national pediatric surgical network and database for gastroschisis (GS) that tracks cases from diagnosis to hospital discharge. Methods The 16-center network serves a population of 32 million. Gastroschisis cases are ascertained at prenatal diagnosis. Perinatal data include maternal risk and fetal ultrasound variables, delivery plan and outcome, a postnatal bowel injury score, intended and actual surgical treatment, and neonatal outcomes. Institutional review board–approved data collection conforms to regional privacy legislation. Deidentified data are centralized and accessible for research through the network steering committee. Results To date, 114 cases of pre- and/or postnatal gastroschisis have been uploaded. Of 106 live-born infants (40 [38%] by cesarean delivery), 100 had complete records, and overall survival to discharge was 96%, with a mean survivor length of stay (LOS) of 46 days. Infants treated with attempted urgent closure (61%) had significantly shorter LOS (42 vs 57days; P = .048) but comparable LOS compared with those treated with silos and delayed closure. Fetal bowel dilation 18 mm or greater did not predict a difference in outcome. Conclusion Population-based databases allow rapid case accrual and enable studies that should aid in the identification of optimal perinatal treatment.

To determine whether neonatal intensive care unit (NICU) outcomes vary by centre for inborn neonates of hypertensive pregnancies and, if so, whether that variation might be related to between-centre variations in obstetric practice.The study comprised a prospective cohort of 13 505 singleton neonates admitted to 17 Canadian NICUs. Adjusting for potential confounders, we used multivariate regression to analyze the relation between centre of delivery and 6 dependent variables: (1) Apgar score7 at 5 minutes; (2) Score of Neonatal Acute Physiology-II (SNAP-II) scoreor = 10; (3) neonatal death; (4) neonatal death or morbidity (owing to bronchopulmonary dysplasia [BPD], intraventricular hemorrhage [IVH], necrotizing enterocolitis [NEC], persistent ductus arteriosus [PDA], or periventricular leukomalacia [PVL]); (5) BPD alone; and (6) major neonatal morbidity (that is, at least one of IVH, PVL, NEC, or PDA). NICU practices known to influence these outcomes were included in the modelling for neonatal death and neonatal morbidity. In a sensitivity analysis for practice variation, antenatal steroid exposure was both included and excluded in each regression.For 5 of the 6 dependent variables, we identified between-centre variation that was not explained solely by variation in antenatal corticosteroid use. Adjusted odds ratios varied from 0.11 to 5.6 (the reference centre was the median rate of the adverse outcome).In the pregnancy hypertension setting, between-centre variations in practice are associated with variations in neonatal physiology and survival. For infants admitted to NICU, the obstetric management of hypertensive pregnancies appears to have an effect on both short- and medium-term neonatal outcomes, even after correction for NICU management.

Purpose Perinatal care of infants with CDH is non-standardized and costly. We examined a risk-adjusted cohort of CDH patients and hypothesized that (1) amongst CDH survivors, the cost of the birth admission would be proportional to illness-severity, and (2) this cost would be significantly higher compared to a matched non-CDH cohort. Methods A retrospective review of costs and outcomes for all patients with CDH admitted to British Columbia Children9s Hospital between 1999 and 2003 was performed. Risk grouping of CDH patients using a validated, admission severity score (SNAP-II) was conducted, enabling comparison amongst infants surviving to discharge. Hospital costs were also compared to a non-CDH cohort matched for birth weight and SNAP-II. Results 32 infants with CDH were included, of whom 5 required ECMO. 23 infants (72%) survived to discharge, with an average LOS of 46 days. Average cost per survivor to discharge was $54,102 (vs $13,722 for the non-CDH cohort; p Conclusions Infants born with CDH require costly care and can be expected to consume disproportionate resources. Admission SNAP-II score correlates with total cost to discharge among lower risk groups. Risk stratification and cost comparison of larger CDH populations may allow identification of cost-efficient treatment strategies.