Abstract
Expectant parents of very preterm infants, physicians, and policy makers require estimates for chances of survival and survival without morbidity. Such estimates should derive from a large, reliable, and contemporary data base of easily available items known at birth. To determine short-term outcome and risk factors in very-low-birth-weight preterm infants based on administrative data. Anonymized routine data sets transmitted from hospital administrations to statutory health insurance companies were used to assess survival and survival free of major morbidities in a large cohort of preterm infants in Germany. After exclusion of infants with lethal malformations, there were 13,147 infants with a birth weight below 1,500 g admitted to neonatal care 2008-2012, of whom 1,432 infants (10.9%) died within 180 days. Estimated 180 days survival probabilities were 0.632 (95% confidence interval 0.583-0.677) for infants with 250-499 g birth weight, 0.817 (0.799-0.834) for 500-749 g, 0.931 (0.920-0.940) for 750-999 g, 0.973 (0.967-0.979) for 1,000-1,249 g, and 0.985 (0.981-0.988) for 1,250-1,499 g. Estimated probabilities for survival without major morbidity (surgically treated intraventricular hemorrhage, necrotizing enterocolitis, intestinal perforation, or retinopathy) were 0.433 (0.384-0.481) for 250-499 g, 0.622 (0.600-0.643) for 500-749 g, 0.836 (0.821-0.849) for 750-999 g, 0.938 (0.928-0.946) for 1,000-1,249 g, and 0.969 (0.964-0.974) for 1,250-1,499 g, respectively. Prediction of survival and survival without major morbidities was moderately improved by adding sex, small for gestational age, and severe or moderate congenital malformation, increasing receiver operating characteristic areas under the curve from 0.839 (0.827-0.850) to 0.862 (0.852-0.874) (survival) and from 0.827 (0.822-0.842) to 0.852 (0.846-0.863) (survival without major morbidities), respectively. The present analysis encourages attempts to use administrative data to investigate the association between risk factors and outcome in preterm infants.
Highlights
In threatened preterm delivery at the threshold of viability, estimating the chances for survival and survival without major morbidities of very preterm infants becomes pivotal when parents and physicians are faced with decisions to begin or withhold treatment
The U.S National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, analyzing data of 4,446 preterm infant with a birth weight of 401–1,000 g admitted 1998–2003 to 19 U.S hospitals, has demonstrated that prediction of survival and survival without major neurodevelopmental impairment can be better estimated by consideration of five a priori selected factors than with use of gestational age alone [13]
The Canadian Neonatal Network has provided graphical representations of the probabilities of survival and survival without major morbidities calculated from gestational age, birth weight, and sex of 17,148 preterm infants admitted 2003–2008 to all major level III neonatal intensive care units in Canada, excluding only those with lethal congenital anomalies, primary palliation, missing values, or extreme outliers [16]
Summary
In threatened preterm delivery at the threshold of viability, estimating the chances for survival and survival without major morbidities of very preterm infants becomes pivotal when parents and physicians are faced with decisions to begin or withhold treatment. It is important when designing interventional trials or for making adjustments in quality improvement efforts that compare hospital performance. Such estimates should derive from a large, reliable, and contemporary data base of available items known at birth
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