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Trends in mortality and morbidity for very low birth weight infants, 1991-1999
Jeffrey D Horbar1, Gary J Badger, Joseph H Carpenter
1University of Vermont Department of Pediatrics, Burlington, Vermont. Vermont Oxford Network, Burlington, Vermont, USA. horbar@vtoxford.org
Insights
Improvements in neonatal care for very low birth weight (VLBW) infants slowed after 1995. While mortality and morbidity decreased in the early 1990s, outcomes for VLBW infants have plateaued since then.
Area of Science:
- Neonatal Medicine
- Perinatal Epidemiology
- Public Health
Background:
- Medical care for very low birth weight (VLBW) infants and mothers underwent significant changes in the 1990s.
- The impact of these changes on VLBW infant mortality and morbidity remains unclear.
Purpose of the Study:
- To identify trends in clinical practices and patient outcomes for VLBW infants.
- To analyze data from the Vermont Oxford Network Database for infants born between 1991 and 1999.
Main Methods:
- Utilized logistic regression to assess temporal trends in practices and outcomes.
- Adjusted for patient characteristics and accounted for hospital clustering.
- Analyzed data from 118,448 VLBW infants across 362 neonatal intensive care units.
Main Results:
- Observed increases in prenatal care, cesarean sections, multiple births, antenatal steroids, and use of respiratory support (CPAP, high-frequency ventilation, surfactant).
- Noted a decline in mortality, pneumothorax, and intraventricular hemorrhage (IVH) from 1991 to 1995.
- Found no significant improvement in mortality or morbidity from 1995 to 1999, with an increase in pneumothorax rates.
Conclusions:
- Major advancements in obstetric and neonatal care occurred during the 1990s.
- These changes initially led to reduced mortality and morbidity in VLBW infants.
- The trend of improving outcomes for VLBW infants ceased after 1995, indicating a plateau in progress.
Background:
Medical care for very low birth weight (VLBW) infants and their mothers has changed dramatically during the 1990s, yet it is unclear how these changes have affected mortality and morbidity.
Objective:
We used the Vermont Oxford Network Database to identify trends in clinical practice and patient outcomes for VLBW infants born from 1991 to 1999.
Methods:
Logistic regression was used to evaluate temporal trends in practices and outcomes while adjusting for patient characteristics and accounting for clustering of cases within hospitals.
Results:
There were 118 448 infants 501 to 1500 g from 362 neonatal intensive care units enrolled in the Network Database from 1991 to 1999. Prenatal care, cesarean section, multiple births, antenatal steroids, and 1-minute Apgar scores increased during this period, as did the use of nasal continuous positive airway pressure, high-frequency ventilation, surfactant, and postnatal steroids. The proportion of white infants decreased; the proportions of Hispanic infants and those of other races increased. The crude and adjusted rates of mortality, pneumothorax, intraventricular hemorrhage (IVH), and severe IVH declined from 1991 to 1995, whereas from 1995 to 1999, the rates of mortality, IVH, and severe IVH did not change significantly, and pneumothorax increased.
Conclusions:
There have been major changes in both obstetric and neonatal care during the 1990s. These changes were associated with decreases in mortality and morbidity for VLBW infants during the first half of the decade. However, since 1995, no additional improvements in mortality or morbidity have been seen, ending a decades-long trend of improving outcomes for these infants.