1390 Neonatal Mortality in Very-Low- Birthweigh Infants (VLBWI) From Two Neonatal Networks in Spain and Japan

Abstract

Background: VLBWI mortality rates vary across NICUs, however few comparisons are available between different national networks. Aim: To compare and analyze differences in neonatal mortality rates of two VLBWI cohorts from Neonatal Networks in Spain and Japan. Methods: Risk/protective factors, complications, and morbi-mortality outcomes were compared among inborn VLBWI admitted to NICU's from SEN-1500 (7,006 infants, 63 NICU's) and NRNJ (8,695 infants, 69 NICU's) from 2005 to 2007. Nonparametric independent comparison analysis and logistic regression models were performed to predict mortality adjusting for perinatal risks factors. Results: Significant differences were found in gestation [mean(SD); 29.3(2.9) vs. 28.6(3.3) wks] and birthweigh [1117(271) vs. 1031(304)g. Both, 28-days neonatal and pre-discharge mortality rates were significantly higher in SEN-1500 (12.5% and 14.7%) than in NRNJ (6.4 and 9.2%). Differences in mortality remained even when adjusting for GA, birthweight, prenatal steroid use, 1 and 5 -min Apgar scores and presence of major congenital anomalies. There were many differences in clinical management among networks. In SEN-1500, use of surfactant and high frequency ventilation and DBP and PDA ligation rates were lower, but had higher rates of NEC, grades3-4 IVH, and specially of sepsis (32.7% vs. 7.3%; p< 0.001). Conclusion: Differences in neonatal and predischarge mortality rates of VLBWI form SEN-1500 and NRNJ could not completely be explained by initial risk and protective factors. Sepsis-related mortality accounted for 61.3% of the excess mortality in SEN-1500. The implementation of systematic preventive strategies for sepsis seems mandatory.