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. 2018 May;103(3):F208-F215.
doi: 10.1136/archdischild-2017-312748. Epub 2017 Sep 7.

Survival of very preterm infants admitted to neonatal care in England 2008-2014: time trends and regional variation

Shalini Santhakumaran  1   2 , Yevgeniy Statnikov  1   2 , Daniel Gray  1   3 , Cheryl Battersby  1   2 , Deborah Ashby  2 , Neena Modi  1   2 ; Medicines for Neonates Investigator Group
Affiliations

Survival of very preterm infants admitted to neonatal care in England 2008-2014: time trends and regional variation

Shalini Santhakumaran et al. Arch Dis Child Fetal Neonatal Ed. 2018 May.

Abstract

Objective: To analyse survival trends and regional variation for very preterm infants admitted to neonatal care.

Setting: All neonatal units in England.

Patients: Infants born at 22+0-31+6 weeks+daysgestational age (GA) over 2008-2014 and admitted to neonatal care; published data for admitted infants 22+0-25+6 weeks+days GA in 1995 and 2006, and for live births at 22+0-31+6 weeks+days GA in 2013.

Methods: We obtained data from the National Neonatal Research Database. We used logistic regression to model survival probability with birth weight, GA, sex, antenatal steroid exposure and multiple birth included in the risk adjustment model and calculated annualpercentage change (APC) for trends using joinpoint regression. We evaluated survival over a 20-year period for infants <26 weeks' GA using additional published data from the EPICure studies.

Results: We identified 50 112 eligible infants. There was an increase in survival over 2008-2014 (2008: 88.0%; 2014: 91.3%; adjusted APC 0.46% (95% CI 0.30 to 0.62) p<0.001). The greatest improvement was at 22+0-23+6 weeks (APC 6.03% (95% CI 2.47 to 3.53) p=0.002). Improvement largely occurred in London and South of England (APC: London 1.26% (95% CI 0.60 to 1.96); South of England 1.09% (95% CI 0.36 to 1.82); Midlands and East of England 0.15% (95% CI -0.56 to 0.86); and North of England 0.26% (95% CI -0.54 to 1.07)). Survival at the earliest gestations improved at a similar rate over 1995-2014 (22+0-25+6 weeks, APC 2.73% (95% CI 2.35 to 3.12), p value for change=0.25).

Conclusions: Continued national improvement in the survival of very preterm admissions masks important regional variation. Timely assessment of preterm survival is feasible using electronic records.

Keywords: data collection; epidemiology; health services research; neonatology.

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Figures

Figure 1
Figure 1
Joinpoint regression analysis for crude rates of survival to discharge for admitted infants born at 22+0–31+6 weeks’ gestation by birth year (2008–2014). APC, average percentage change.
Figure 2
Figure 2
Survival to discharge for infants born 23–25 weeks and admitted to neonatal units in England in 1995 (EPICure; triangle symbol), 2006 (EPICure 2; cross symbol) and 2008–2014 (NNRD; circle symbol). APC, average percentage change; NNRD, National Neonatal Research Database; NNU, neonatal unit.
See this image and copyright information in PMC

References

    1. Lawn JE, Cousens S. Zupan J for the Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? where? why? Lancet 2005;365:891–900. - PubMed
    1. Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008;371:261–9. 10.1016/S0140-6736(08)60136-1 - DOI - PubMed
    1. Marlow N. Keeping up with outcomes for infants born at extremely low gestational ages. JAMA Pediatr 2015;169:207–8. 10.1001/jamapediatrics.2014.3362 - DOI - PubMed
    1. Gale C, Morris I. Neonatal Data Analysis Unit (NDAU) Steering Board. The UK National Neonatal Research Database: using neonatal data for research, quality improvement and more. Arch Dis Child Educ Pract Ed 2016;101:216–8. 10.1136/archdischild-2015-309928 - DOI - PMC - PubMed
    1. Department for Communities and Local Government. The English Indices of Deprivation 2010, Technical report, Department of Communities and Local Governement. London, 2011. https://www.gov.uk/government/statistics/english-indices-of-deprivation-....