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Learning From Strengths: Improving Care by Comparing Perinatal Approaches Between Japan and Canada and Identifying Future Research Priorities

      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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