Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

Anthony Debay; Prakesh Shah; Abhay Lodha; Sandesh Shivananda; Stephanie Redpath; Mary Seshia; Jon Dorling; Anie Lapointe; Rody Canning; Lannae Strueby; Marc Beltempo; on behalf of the Canadian Neonatal Network Investigators

doi:10.1055/a-1772-4637

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(06): 747-755
DOI: 10.1055/a-1772-4637

Original Article

Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

Anthony Debay

¹Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada

,

Prakesh Shah

²Departement of Pediatrics, Toronto University, Toronto, Ontario, Canada

,

Abhay Lodha

³Departement of Pediatrics, University of Calgary, Calgary, Alberta, Canada

,

Sandesh Shivananda

⁴Departement of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada

,

Stephanie Redpath

⁵Departement of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

,

Mary Seshia

⁶Departement of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada

,

Jon Dorling

⁷Departement of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada

,

Anie Lapointe

⁸Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada

,

Rody Canning

⁹Departement of Pediatrics, Moncton Hospital, Moncton, Alberta, Canada

,

Lannae Strueby

¹⁰Departement of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

,

Marc Beltempo

¹Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada

,

on behalf of the Canadian Neonatal Network Investigators

› Author Affiliations

Abstract

Objective This study aimed to assess if 24-hour in-house neonatologist (NN) coverage is associated with delivery room (DR) resuscitation/stabilization and outcomes among inborn infants <29 weeks' gestational age (GA).

Study design Survey-linked cohort study of 2,476 inborn infants of 23 to 28 weeks' gestation, admitted between 2014 and 2015 to Canadian Neonatal Network Level-3 neonatal intensive care units (NICUs) with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-hour in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, and retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders.

Results Among the 28 participating NICUs, most senior providers ensuring 24-hour in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-hour fellow coverage were associated with higher odds of infants receiving DR chest compressions/epinephrine compared with 24-hour NN coverage (adjusted odds ratio [aOR] = 4.72, 95% confidence interval [CI]: 2.12–10.6 and aOR = 3.33, 95% CI: 1.44–7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants).

Conclusion 24-hour in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out.

Key Points

Lower rates of DR cardiopulmonary resuscitation with 24h in-house NN coverage
The type of 24h in-house coverage was not associated with mortality and/or major morbidity.
High-volume centers more often have 24h in-house neonatal fellow coverage

Keywords

prematurity - coverage - neonatal intensive care unit - resuscitation - delivery room - cardiopulmonary resuscitation - neonatologist

Full Text

References

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Supplementary Material

Supplementary Material