Abstract
BackgroundOver the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants. Only a few publications analyse changes of their short-term outcome in a geographically defined area over more than 10 years. We therefore aimed to investigate the net change of VP- and VLBW infants leaving the hospital without major complications.MethodsOur population-based observational cohort study used the Minimal Neonatal Data Set, a database maintained by the Swiss Society of Neonatology including information of all VP- and VLBW infants. Perinatal characteristics, mortality and morbidity rates and the survival free of major complications were analysed and their temporal trends evaluated.ResultsIn 1996, 2000, 2004, and 2008, a total number of 3090 infants were enrolled in the Network Database. At the same time the rate of VP- and VLBW neonates increased significantly from 0.87% in 1996 to 1.10% in 2008 (p < 0.001). The overall mortality remained stable by 13%, but the survival free of major complications increased from 66.9% to 71.7% (p < 0.01). The percentage of infants getting a full course of antenatal corticosteroids increased from 67.7% in 1996 to 91.4% in 2008 (p < 0.001). Surfactant was given more frequently (24.8% in 1996 compared to 40.1% in 2008, p < 0.001) and the frequency of mechanical ventilation remained stable by about 43%. However, the use of CPAP therapy increased considerably from 43% to 73.2% (p < 0.001). Some of the typical neonatal pathologies like bronchopulmonary dysplasia, necrotising enterocolitis and intraventricular haemorrhage decreased significantly (p ≤ 0.02) whereas others like patent ductus arteriosus and respiratory distress syndrome increased (p < 0.001).ConclusionsOver the 12-year observation period, the number of VP- and VLBW infants increased significantly. An unchanged overall mortality rate and an increase of survivors free of major complication resulted in a considerable net gain in infants with potentially good outcome.
Highlights
Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants
The Network comprises all nine Neonatal Intensive Care Units (NICUs), most of the smaller Neonatal Units (NUs) and most Neuropediatric Centres caring for VP and VLBW infants in Switzerland under the auspices of the Swiss Society of Neonatology
The rates of VLBW infants in Switzerland increased significantly from 0.76% to 0.97% (p96-08 < 0.001, b = 0.06%). 3090 infants with less than 32 completed gestational weeks and/or with a birth weight less than 1500 g were included for further analysis
Summary
Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants. We aimed to investigate the net change of VP- and VLBW infants leaving the hospital without major complications. Very preterm birth is a major cause of mortality and morbidity for newborns and imposes a considerable burden on limited health care resources. Over the last two decades, changes in perinatal management have been associated with a significant increase and better outcome of these infants [1,2]. Referring to previous population-based studies, we hypothesised that improvement in obstetric and perinatal management led to a decrease in mortality resulting in more survivors with disability
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