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Changes in perinatal care and survival in very preterm and extremely preterm infants in The Netherlands between 1983
Sabine Anthony1, Lya den Ouden, Ronald Brand
1Child Health Division, TNO Prevention and Health, PO Box 92215, 2301 CE Leiden, The Netherlands. s.anthony@pg.tno.nl
Insights
Improved obstetrical and neonatal care for very preterm infants in The Netherlands led to increased survival rates from 75% to 90% between 1983 and 1995.
Area of Science:
- Neonatal Medicine
- Obstetrics
- Perinatal Care
Background:
- Significant advancements in neonatal care have occurred.
- Changes in obstetrical and neonatal practices may impact outcomes for preterm infants.
Purpose of the Study:
- To assess shifts in obstetrical and neonatal care for very preterm and extremely preterm infants.
- To determine the impact of these care changes on infant outcomes.
Main Methods:
- Comparative analysis of national databases for infants born in 1983 and 1995.
- Inclusion criteria: very preterm or very low birth weight (VLBW) infants.
- Data comparison included obstetrical interventions and neonatal management.
Main Results:
- Increased delivery in tertiary centers (35.7% to 60.7%) and C-section rates (43.7% to 56.8%).
- Prolonged artificial ventilation increased (3.4% to 9.5%).
- Survival to discharge rose from 75% to 90%; neonatal morbidity decreased relatively.
Conclusions:
- Short-term outcomes for very preterm and extremely preterm infants have improved.
- Long-term follow-up is crucial to understand the sequelae of intensive care interventions.
Objective:
To evaluate changes in obstetrical and neonatal care for very preterm and extremely preterm infants between 1983 and 1995 in The Netherlands and to evaluate the effect of those changes.
Study Design:
Data on all very preterm or VLBW infants from the linked national obstetrical and neonatal databases of 1995 (N=2066) were compared to data on similar infants from a nation-wide study of very preterm infants born in 1983 (N=1338).
Results:
Obstetrical and neonatal management changed over time, with an increased number of deliveries in tertiary centres (35.7-60.7%), an increase in C-sections (43.7-56.8%) and prolonged artificial ventilation (3.4-9.5%). Survival until discharge increased from 75 to 90% and neonatal morbidity decreased in relative terms.
Conclusions:
The short-term outcome for these very preterm and extremely preterm infants has improved. Long-term follow-up through to school age and adulthood of preterm infants is needed to investigate the changes in the sequelae of intensive obstetrical and neonatal care.
