Author(s): Regger C, Hegglin M, Adams M, Bucher HU Swiss Neonata
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Abstract BACKGROUND: 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. 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. METHODS: Our 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. RESULTS: In 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). CONCLUSIONS: Over 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.
This article was published in BMC Pediatr
and referenced in Journal of Neonatal Biology