OUR COLLABORATIONS
Necrotizing enterocolitis (NEC) is a condition of inflammation and possible perforation of the small or large intestine in premature babies; thus there is an increased risk for sepsis and the infant may require surgery. The exact cause of NEC remains unknown. Recent developments have suggested that one mechanism for the development of NEC in preterm infants is feeding around the time of red blood cell transfusions. While this correlation between exposure and outcome may indicate good reason to stop feeding around the time of transfusions, little randomized clinical data has been provided to justify this protocol. Delaying feeding may pose a risk of acquiring invasive infections which may ultimately result in NEC. Therefore, it is unclear if delaying feeding at the time of transfusion positively impacts the risk of developing NEC in preterm infants.
The WHEAT trial (WithHolding Enteral feeds Around packed red cell Transfusion) is a randomized, multicentre trial with the goal of resolving the uncertainty surrounding the best course of care for preterm infants receiving red blood cell transfusions upon admission to a NICU. Infants born at at least 30 weeks gestational age are enrolled in this opt-out study. Participants in this trial will be randomized to receive care of either withholding feeds around transfusion (4 hours prior, 4 hours during, and 4 hours post—12 hours in total), or continuing feeds during transfusion. The main outcomes of interest are a diagnosis of severe NEC, spontaneous intestinal perforation, all-cause mortality, central line-associated blood stream infections, and changes in birth weight and head circumference to assess growth.
Our team at the Montreal Children’s Hospital is participating in recruitment and data collection for this study.
For more information on the WHEAT trial, please click on the title above.
Premature infants are born with underdeveloped lungs, and infants born prior to 29 weeks gestational age are even less developed at birth. Their limited lung development may require them to be resuscitated at birth, which is challenging due to their undeveloped lungs and brain. Oxygen is used during this process, however the concentration of oxygen which is best to prevent major disability (e.g. cerebral palsy, major developmental delay, visual or hearing impairments) is unclear.
The Hi-Lo trial (Higher versus Lower) is a multicentre, clustered randomized trial which randomly assigns hospitals to apply a policy of 30% or 60% oxygen concentration during delivery room resuscitation in infants born between 20 to 29 weeks gestation. Infants who enrol in the study are followed-up at 18-24 months to assess for major disability. In-hospital outcomes of interest include assessing for all-cause mortality and major brain injury.
Our team at the Montreal Children’s Hospital is participating in recruitment and data collection for this study.
For more information on the Hi-Lo trial, please click on the title above.
Preterm infants and late preterm infants with complications will be admitted to a Neonatal Intensive Care Unit (NICU) for close monitoring and care. These infants will be admitted to a Level-2 (specialty care for infants who have short-term complications or are recovering), or a Level-3 NICU (specialty care for infants who have more serious complications and are more vulnerable). Investigating resource use, infant outcomes, and care practices in the NICU is important to advance the efficiency and quality of neonatal care in Canada. The Canadian Neonatal Network was established by Dr. Shoo Lee for the purpose of fostering “national collaborative research into neonatal care”.
The Canadian Neonatal Network (CNN) is a network affiliated with all 31 Level-3 NICUs in Canada, with trained personnel at each location to provide standardized data reporting on patient characteristics and outcomes for infants admitted to the unit. Members of the CNN are often researchers who foster collaboration with healthcare professionals and administrators in these initiatives. Thus, more effective collaboration in research to advance neonatal care and outcomes (e.g. population health, medical sciences, epidemiology) is made possible.
Dr. Marc Beltempo is currently the Associate Director for the Canadian Neonatal Network. The Neonatal Health Systems Lab frequently uses the CNN database in its research.
For more information on the Canadian Neonatal Network, please click on the title above.
