Oral or Poster Presentation
Concurrent Session 3A - Neonatal Clinical Epidemiology
Introduction: Several post-natal preventive interventions (PI) have been proposed to reduce the risk of death and/or necrotizing enterocolitis (NEC) among high risk infants born <29 weeks gestational age (GA). We aimed to investigate the cumulative effect of four post-natal PI on the risk of death/NEC among infants born <29 weeks GA.
Methods: Retrospective cohort study of infants born from 220-286 weeks who survived >3 days and admitted to NICUs participating in the Canadian Neonatal Network from 2014-2018. The four PIs were: early initiation of feeds <2 days after birth (EIF), judicious use of antibiotics for <3 days for suspected early-onset sepsis with negative cultures (Jatb), exclusive human milk diet for ≥4 weeks (EBM) and use of prophylactic probiotics (PP). The effect of exposure to one, two, three and all four practices on death/NEC ≥ stage 2 was assessed using multivariable logistic regression adjusted for patient characteristics.
Results: Rate of death/NEC was 16% (1151/7338) and varied based on exposure to PI: none, 18.2% (79/434); one, 16.5% (375/2280); two, 15.1% (404/2665); three, 15.3% (247/1611); all, 13.2% (46/348). Significantly lower odds of death/NEC were observed with exposure to EIF (adjusted odds ratio [AOR] 0.73, 95% CI 0.73-0.97) and PP (AOR 0.66, 95% CI 0.52-0.85) but not with Jatb (AOR 1.13, 95% CI 0.98-1.3) and EBM (AOR 0.9, 95% CI 0.59-1.36). Compared to infants exposed to no PIs, odds of death/NEC were lower among infants exposed to one PI (AOR 0.67, 95% CI 0.47-0.95), two PIs (AOR 0.6, 95% CI 0.41-0.86), three PIs (AOR 0.59, 95% CI 0.38-0.9) and four PIs (AOR 0.49, 95% CI 0.28-0.85).
Conclusion: Among infants born <29 weeks, exposure to higher number of PIs is associated with decreasing odds of death/NEC. However, this association seems mainly driven by a reduction in mortality.