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. 2012 Feb 22:12:17.
doi: 10.1186/1471-2431-12-17.

Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years

Christoph Rüegger  1 , Markus Hegglin, Mark Adams, Hans Ulrich Bucher; Swiss Neonatal Network
Collaborators, Affiliations

Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years

Christoph Rüegger et al. BMC Pediatr. .

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.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curve per year.
Figure 2
Figure 2
Gestational age stratified survival free of major complications.
Figure 3
Figure 3
Gestational age stratified length of stay.
Figure 4
Figure 4
Cumulative curve of survivors with CPAP treatment per year.
See this image and copyright information in PMC

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