ABSTRACT
Objective
Preterm birth (PTB) is the leading cause of infant morbidity and mortality worldwide.
Canada and Japan each have strengths that can inform clinical decision-making, research,
and health care policy regarding the prevention of PTB and its sequelae. Our objectives
were to: 1) compare PTB rates, risk factors, management, and outcomes between Japan
and Canada; 2) establish research priorities while fostering future collaborative
opportunities; and 3) undertake knowledge translation of these findings.
Methods
We conducted a literature review to identify publications that examined PTB rates,
risk factors, prevention and management techniques, and outcomes in Japan and Canada.
We conducted site visits at 4 Japanese tertiary centres and held a collaborative stakeholder
meeting of parents, neonatologists, maternal–fetal medicine specialists, and researchers.
Results
Japan reports lower rates of PTB, neonatal mortality, and several PTB risk factors
than Canada. However, Canadian PTB data is population-based, whereas, in Japan, the
rate of PTB is population-based, but outcomes are not. Rates of severe neurologic
injury and necrotizing enterocolitis were lower in Japan, while Canada's rates of
bronchopulmonary dysplasia and retinopathy of prematurity were lower. PTB prevention
approaches differed, with less progesterone use in Japan and more long-term tocolysis.
In Japan, there were lower rates of neonatal transfers and non-faculty overnight care,
but also less use of antenatal corticosteroids and deferred cord clamping. Research
priorities identified through the stakeholder meeting included early skin-to-skin
contact, parental well-being after PTB, and transitions in care for the child.
Conclusion
We identified key differences between Japan and Canada in the factors affecting PTB
management and patient outcomes, which can inform future research efforts.
RÉSUMÉ
Objectif
La naissance avant terme (NAT) est la principale cause de morbidité et mortalité chez
les nourrissons à l’échelle planétaire. Le Canada et le Japon ont tous deux des atouts
qui peuvent éclairer la prise de décision clinique, la recherche et la politique de
santé publique concernant la prévention de la NAT et de ses séquelles. Nos objectifs
étaient les suivants : 1) comparer les taux de NAT, les facteurs de risque, la prise
en charge et les résultats entre le Japon et le Canada; 2) établir les priorités de
recherche tout en favorisant les occasions de collaboration futures; et 3) entreprendre
la diffusion des connaissances issues de ces résultats.
Méthodologie
Nous avons effectué une revue de la littérature pour repérer les publications examinant
le taux de NAT, les facteurs de risque, les techniques de prévention et de prise en
charge et les issues au Japon et au Canada. Nous avons effectué des visites dans 4 centres
tertiaires au Japon et tenu une réunion collaborative entre intervenants, dont des
parents, des néonatologistes, des spécialistes en médecine fœto-maternelle et des
chercheurs.
Résultats
Par rapport au Canada, le Japon obtient de meilleurs résultats pour ce qui est des
NAT, des mortalités néonatales et de plusieurs facteurs de risque de NAT. Toutefois,
les données canadiennes sur la NAT sont basées sur la population, tandis que, au Japon,
le taux de NAT est basé sur la population, mais les issues ne le sont pas. Les taux
d'atteinte neurologique grave et d'entérocolite nécrosante étaient plus faibles au
Japon, tandis que les taux de dysplasie broncho-pulmonaire et de rétinopathie du prématuré
étaient plus faibles au Canada. Les stratégies de prévention de la NAT sont différentes
entre les deux pays : au Japon, la progestérone est moins utilisée, mais la tocolyse
à long terme l'est davantage. Au Japon, les taux de transferts en néonatalogie et
de soins de plus de 24 heures sans médecin titulaire étaient plus faibles, mais on
y utilise aussi moins la corticothérapie prénatale et le clampage retardé du cordon.
Les priorités de recherche cernées lors de la réunion des intervenants sont le contact
précoce peau à peau, le bien-être parental après une NAT et les transitions de soins
pour l'enfant.
Conclusion
Nous avons défini les principales différences entre le Japon et le Canada quant aux
facteurs qui influent sur la prise en charge de la NAT et sur les résultats cliniques,
ce qui pourra étayer les recherches à venir.
Keywords
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Article info
Publication history
Published online: May 17, 2021
Footnotes
Disclosures: This report received funding from the Canadian Institutes of Health Research (CIHR), Funding Reference Number PCS-164983. SDM is supported by a Tier II Canada Research Chair. Neither funding agency had any role this study. The authors declare no financial support or competing interests for this project.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
