Abstract
BackgroundRecent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH.MethodsCohort study of 1414 VLBW infants cared for in a single level III neonatal intensive care unit in Delaware from 1993–2002. Infants were divided into consecutive 3-year cohorts. Illness severity was measured by two objective methods: the Score for Neonatal Acute Physiology (SNAP), based on data from the 1st day of life, and total thyroxine (T4), measured on the 5th day of life. Death before hospital discharge and severe intraventricular hemorrhage (IVH) were investigated in the study sample in relation to illness severity. The fetal death rate was also investigated. Statistical analyses included both univariate and multivariate analysis.ResultsIllness severity, as measured by SNAP and T4, increased steadily over the 9-year study period with an associated increase in severe IVH and the combined outcome of death and/or severe IVH. During the final 3 years of the study, the observed increase in illness severity accounted for 86% (95% CI 57–116%) of the variability in the increase in death and/or severe IVH. The fetal death rate dropped from 7.8/1000 (1993–1996) to 5.3/1000 (1999–2002, p = .01) over the course of the study.ConclusionThese data demonstrate a progressive increase in illness in VLBW infants over time, associated with an increase in death and/or severe IVH. We speculate that the observed decrease in fetal death, and the increase in neonatal illness, mortality and/or severe IVH over time represent a shift of severely compromised patients that now survive the fetal time period and are presented for care in the neonatal unit.
Highlights
Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's
In the state of Delaware, infant mortality rates improved during the early 1990s similar to national trends, only to see a more recent increase which has been attributed to increasing mortality in very low birth weight infants [4]
As the fetal mortality rate has been declining in the United States [6], and may be leading to a shift from fetal death to physiologically compromised preterm infants, we explored the fetal death rate at our institution during the study time period
Summary
Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH. Despite continuing advances in neonatal care and decades of improving outcomes, it has recently been reported that survival rates have leveled-off in premature infants during the 1990s [1,2,3]. In the state of Delaware, infant mortality rates improved during the early 1990s similar to national trends, only to see a more recent increase which has been attributed to increasing mortality in very low birth weight infants [4]. In 2002 the United States fetal mortality rate declined while infant mortality increased [6]. The potential impact of increasing fetal survival on neonatal intensive care has not been explored
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