Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers

Abstract

To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31,2016. A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500g and 23-35weeks of gestation. We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081±281g and a gestational age of 28.8±2.9weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P<.001), late onset sepsis from 21.1% to 19.5% (P=.002), retinopathy of prematurity from 21.3% to 13.8% (P<.001), and hydrocephalus from 3.8% to 2.4%(P<.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P=.043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P<.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P<.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P<.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P<.001). Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.