Cumulative effect of evidence-based practices on outcomes of preterm infants born at <29 weeks gestational age

Abstract - Structured Background Extremely preterm infants born at Objective To investigate the cumulative effect of four EBPs and their association with death and/or SNI among infants born at Study Design Observational study of infants born at 230-286 weeks GA admitted to NICUs participating in the Canadian Neonatal Network from 2015-2017. We evaluated four practices: antenatal corticosteroids (ACS), antenatal MgSO4 for neuroprotection (MgSO4), deferred cord clamping ≥30 seconds (DCC) and normothermia on admission (NT). The effect of exposure to one, two, three and all four EBPs compared to none on death and/or SNI was assessed using multivariable logistic regression models adjusted for patient characteristics. Results Rate of death and/or SNI was 20% (873/4297) and varied based on exposure to EBPs: none, 34% (54/157); one, 27% (171/626); two, 20% (295/1448); three, 18% (263/1448); all four, 14% (90/618). Significantly lower odds of death and/or SNI were observed with exposure to ACS (adjusted odds ratio [AOR] 0.52, 95% CI 0.40-0.69) and DCC (AOR 0.81, 95% CI 0.68-0.96), but not MgSO4 (AOR 0.88, 95% CI 0.72-1.08) or NT (AOR 0.96, 95% CI 0.79-1.16). Infants exposed to ≥2 EBPs had significantly lower odds of death and/or SNI than those exposed to no EBPs (AOR 0.61, 95% CI 0.43-0.88). Conclusion Among infants born at