title: Outcome comparison of very preterm infants cared for in the neonatal intensive care units in Australia and New Zealand and in Canada.
abstract: OBJECTIVE
  To compare risk-adjusted neonatal intensive care unit outcomes between regions of similar population demography and health-care systems in Australia-New Zealand and Canada to generate meaningful hypothesis for outcome improvements.
  
  
  METHODS
  Retrospective study of data from preterm infants (<32 weeks gestational age) cared for in 29 ANZNN (Australian and New Zealand Neonatal Network) and 26 Canadian Neonatal Network (CNN) intensive care unit admitted between 2005 and 2007. Moribund infants or those with major congenital malformation were excluded.
  
  
  RESULTS
  The 9995 ANZNN infants had a higher gestational age (29 vs. 28 weeks, P < 0.0001), lower rate of outborn status (13.2% vs. 19.1%, P < 0.0001) and Apgar score <7 at 5 min (14.8% vs. 21.6%, P < 0.0001) than their 7141 CNN counterparts. After adjustment, ANZNN and CNN infants had a similar likelihood of survival (adjusted odds ratio (AOR) 1.01 (0.88, 1.16)), but ANZNN infants were at lower risk of severe retinopathy (AOR 0.71 (0.61, 0.83)), severe ultrasound neurological injury (AOR 0.68 (0.59, 0.78)), necrotising enterocolitis (AOR 0.65 (0.56, 0.76)), chronic lung disease (AOR 0.67 (0.62, 0.73)) and late-onset sepsis (AOR 0.83 (0.76, 0.91)). ANZNN infants were at a higher risk of pulmonary air leak (AOR 1.20 (1.01, 1.42)), early-onset sepsis (AOR 1.33 (1.02, 1.74)). More ANZNN infants received any respiratory support (AOR 1.27 (1.14, 1.41)) and continuous positive airway pressure as sole respiratory support (AOR 2.50 (2.27, 2.70)).
  
  
  CONCLUSIONS
  Despite similarities in settings, ANZNN infants fared better in most measures. Outcome disparities may be related to differences in tertiary service provision, referral and clinical practices.
authors: Department of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors: Sadia
authors: S
authors: Hossain
authors: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.|Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Prakesh S
authors: PS
authors: Shah
authors: Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Xiang Y
authors: XY
authors: Ye
authors: Department of Paediatrics, University of Otago, Christchurch, New Zealand.
authors: Brian A
authors: BA
authors: Darlow
authors: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.|Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Shoo K
authors: SK
authors: Lee
authors: Department of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
authors: Kei
authors: K
authors: Lui
mesh_terms: D001315:Australia; D002170:Canada; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D016015:Logistic Models; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: benchmarking; neonatal intensive care unit; network; outcome measure; preterm infant