Evidence map›Paper›PMID 39173602›Full record

ArticleNeonatology2025

Neonatal Adverse Outcomes among Hospital Livebirths in Canada: A National Retrospective Study.

Chantal R M Nelson, Joel G Ray, Nathalie Auger, Aideen M Moore, Julian Little, Phil A Murphy, Michiel Van den Hof, Prakesh S Shah, Canadian Perinatal Surveillance System, Public Health Agency of Canada

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In one paragraph

Article in Neonatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Pregnancy Outcomes Among Individuals With Cerebral Palsy: A Population-Based Cohort Study.BJOG : an international journal of obstetrics and gynaecology · 2026
    Article
  2. Article
  3. Article
  4. Adequacy of Prenatal Care and Ensuing Maternal and Neonatal Severe Morbidity and Mortality.BJOG : an international journal of obstetrics and gynaecology · 2026
    Article
  5. Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Chantal R M NelsonMaternal and Infant Health Section, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada.
Joel G RayDepartments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynaecology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Nathalie AugerInstitut national de santé publique du Québec, Montreal, Québec, Canada.
Aideen M MooreDepartment of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Julian LittleSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Phil A MurphyNewfoundland and Labrador Health Services, St. John's, Newfoundland, Canada.
Michiel Van den HofDepartment of Obstetrics and Gynaecology, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada.
Prakesh S ShahDepartment of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
Canadian Perinatal Surveillance System, Public Health Agency of Canada

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.

methodsThis Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information's Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia's NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5).

resultsAmong 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6-9.5) with 1, 118.1 (108.4-128.4) with 3, and 395.3 (367.2-425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6-6.7), 11.2 (10.9-11.3), and 11.9 (11.6-12.2), and RR for extended hospital stay were 6.6 (6.4-6.7), 12.2 (11.7-12.7), and 26.4 (25.2-27.5). International comparison suggested that Canada had a higher prevalence of NAOI.

conclusionThe Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years.

introductionIn Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking.

methodsThis Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information's Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia's NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5).

resultsAmong 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6-9.5) with 1, 118.1 (108.4-128.4) with 3, and 395.3 (367.2-425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6-6.7), 11.2 (10.9-11.3), and 11.9 (11.6-12.2), and RR for extended hospital stay were 6.6 (6.4-6.7), 12.2 (11.7-12.7), and 26.4 (25.2-27.5). International comparison suggested that Canada had a higher prevalence of NAOI.

conclusionThe Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years.

Indexed as

Infant MortalityInfant, Newborn, DiseasesLive BirthCanadaCross-Sectional StudiesFemaleGestational AgeHumansInfantInfant, NewbornInfant, PrematureIntensive Care Units, NeonatalLength of StayMalePregnancyRetrospective StudiesAdverse eventsInfantNeonatal morbidityNeonatal mortality

Identifiers

PMID39173602
PMCPMC11809516

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.