Clinical Associate Professor
Neonatologist, Department of Paediatrics
Peter Lougheed Centre
Room 3608, 3500 - 26th Avenue NE
Calgary AB T1Y 6J4
The main purpose of my research is to increase the quality of care and improve survival and morbidity rates for preterm newborn infants in Latin America by establishing a neonatal network with accurate data collection translating it into information and implementing evidence based practice changes.
In Ibero American countries, the neonatal mortality ranges between 6 per a 1000 live births in Costa Rica to 22 per a 1000 live births in Bolivia. Deaths due to prematurity is of great concern as the percentage of deaths in infants of less than 5 years due to prematurity varies from 15% in countries like Bolivia and Uruguay to 25% in Paraguay. Likewise, deaths in infants of less than 5 years due to neonatal sepsis are significant varying from 1% in countries like El Salvador and Guatemala to 8% in Venezuela, Brazil and Bolivia. (year 2008 in WHO report of 2011).
In Iberoamerican countries 15 - 25% of the mortality of all infants less than 5 years of age is attributed to prematurity. In addition to high mortality rates, serious morbidities are frequent in survivors. Such as nosocomial infection (NI; 22%), chronic lung disease (CLD; 26%), severe intraventricular hemorrhage (IVH; 10%), severe retinopathy of prematurity and blindness (ROP; 11%), and impaired neurodevelopment. Among older children that were born preterm, significant learning disabilities, educational difficulties and behavioral problems have been reported, with up to 34% repeating a grade. There is very limited data in follow up for Iberoamerican countries, but available publications demonstrate that the rates of mortality and severe morbidity in this region of the world are significantly worse than the ones in developed countries. It is therefore important for the welfare of society as a whole that we address the growing epidemic of preterm birth head on, by taking measures to reduce both its incidence, and associated mortality and morbidity. Many deaths and morbidities are to a great extend preventable by improving quality of care in the NICU settings.
In many neonatal centers in Latin America there is an urgent need for accurate collection and interpretation of outcome data in real time. This is currently either non existent, incomplete or inaccurate. Therefore, there is very limited possibility or opportunity for benchmarking, collaboration in an active neonatal network for improvements in quality of care or measurement of the impact of evidence base changes in clinical practices on neonatal outcomes.
Objectives: We hypothesize that the introduction of high-quality evidence into a highly receptive and supportive clinical environment will optimize knowledge translation outcomes, producing positive changes in professional/patient outcomes, with decrease mortality and morbidity and overal costs. We have implemented a QI program called EPIQ in 15 units since July 2014, and making changes to improve care by repetitive cycles with measures of procedures and outcomes. We will continue to do so over the next few years and measurements of outcomes such as mortality, morbidity related to the prematurity will be taken. This project is modelled from the CNN EPIQ program that has been very successful in the canadian NICUs.