Toward evidence-based best practices in neonatal surgical care-I: The Canadian NICU Network.

BACKGROUND/PURPOSE: The Canadian Neonatal Network collects clinical data prospectively on every admission to each of its 17 tertiary level units in Canada. The purpose of this study was to interrogate the network database to determine case volumes, outcomes, and resource utilization for several neonatal surgical conditions.

METHODS

The network database was used to measure a population-based, profile of incidence, outcome and resource utilization over a 22-month period for the following International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes: 741, spina bifida; 748.4, congenital cystic lung disease; 750.3, tracheoesophageal fistula; 751.1, atresia/stenosis of small intestine; 751.2, atresia/stenosis of large intestine/imperforate anus; 751.3, Hirschsprung's disease; 756.6, anomalies of the diaphragm; 756.7, anomalies of the abdominal wall. Also, all infants receiving extracorporeal membrane oxygenation (ECMO) during the study period were identified.

RESULTS

Case volumes corresponding to each diagnostic code were as follows: 741 (104), 748.4 (12), 750.3 (124), 751.1 (142), 751.2 (121), 751.3 (67), 756.6 (88), 756.7 (151), ECMO cases (28). As a group, infants in the database who required major surgery consumed a disproportionate share of resources and had poorer outcomes than those who did not require major surgery.

CONCLUSIONS

The Canadian Neonatal Network database enables population-based outcomes analysis for specific diagnoses, which, if supplemented by additional pre-and postnatal data fields for surgical conditions, could contribute to the determination of evidence-based best practices for these patients.