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Perinatal health services organization for preterm births: a multinational comparison

Journal of Perinatology volume 37, pages 762–768 (2017)Cite this article

Subjects

Abstract

Objective:

To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks’ gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo).

Study Design:

We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK.

Results:

All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of ‘step-down’ units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified.

Conclusions:

Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.

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Acknowledgements

We would like to thank Natasha Musrap, PhD, from the Maternal-Infant Care Research Centre at Mount Sinai Hospital for editorial assistance in the preparation of this manuscript. PSS had full access to all the data in the study and takes final responsibility for the decision to submit for publication. We gratefully acknowledge all investigators and contributing NNUs listed in the Supplementary Information. Funding for iNeo has been provided by a Canadian Institutes of Health Research Applied Research Chair (APR-126340) in Reproductive and Child Health Services and Policy Research held by PSS. The Canadian Neonatal Network is funded by financial support from the Canadian Institutes of Health Research and individual participating centers. The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from participating centers. The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. TIN Toscane online Network is funded by the Tuscany Region. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. SEN1500 is supported by funds from the Spanish Neonatal Society. The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs) and the body of regional health care providers (County Councils). SwissNeoNet is partially funded by participating units in the form of membership fees. The United Kingdom Neonatal Collaborative receives no core funding.

Author contributions

LEK reviewed the literature, collected and analyzed the data and drafted the initial manuscript. PSS and NM conceptualized the idea, designed the study, supervised data analyses, acquired national population data, revised the initial manuscript and approved the final manuscript. SK, FR, SKL, DB, KL, GS, BR, MA, BAD, MV, LG, LL, LSF and SH conceptualized the idea, designed the study, completed the survey, acquired national population data, revised and approved the final manuscript.

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Authors and Affiliations

  1. Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada

    L E Kelly, P S Shah & S K Lee

  2. Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada

    P S Shah & S K Lee

  3. Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden

    S Håkansson & G Sjörs

  4. Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan

    S Kusuda

  5. Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland

    M Adams & D Bassler

  6. Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain

    M Vento & L S Feliciano

  7. Unit of Epidemiology, TIN Toscane Online, Meyer Children’s University Hospital, Regional Health Agency, Florence, Italy

    F Rusconi

  8. Department of Pediatrics, Finnish Medical Birth Register and Register of Congenital Malformations, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland

    L Lehtonen

  9. Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel

    B Reichman

  10. Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand

    B A Darlow

  11. National Perinatal Epidemiology and Statistic Unit, Australian and New Zealand Neonatal Network, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia

    K Lui

  12. Division of Pediatrics and Neonatology, Ospedale Versilia, Viareggio, Italy

    L Gagliardi

  13. Department of Medicine, Neonatal Data Analysis Unit, Section of Neonatal Medicine, UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK

    N Modi

Authors
  1. L E Kelly
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  2. P S Shah
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  3. S Håkansson
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  4. S Kusuda
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  5. M Adams
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  6. S K Lee
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  7. G Sjörs
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  8. M Vento
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  9. F Rusconi
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  10. L Lehtonen
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  11. B Reichman
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  12. B A Darlow
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  13. K Lui
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  14. L S Feliciano
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  15. L Gagliardi
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  16. D Bassler
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  17. N Modi
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Consortia

for the investigators of the International Network for Evaluating Outcomes (iNeo) of Neonates

Corresponding author

Correspondence to P S Shah.

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Competing interests

The authors declare no conflict of interest.

Additional information

Contributing neonatal units

A list of NNUs and site investigators are listed in the Supplementary Information.

Supplementary Information accompanies the paper on the Journal of Perinatology website .

Supplementary information

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Kelly, L., Shah, P., Håkansson, S. et al. Perinatal health services organization for preterm births: a multinational comparison. J Perinatol 37, 762–768 (2017). https://doi.org/10.1038/jp.2017.45

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  • DOI: https://doi.org/10.1038/jp.2017.45

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