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Regionalized long-term follow-up
1Department of Paediatrics and Ritchie Centre for Baby Health Research, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia. victor.yu@med.monash.edu.au
Insights
Long-term follow-up of Victorian infants shows improved survival and quality of survival for extremely preterm and low-birthweight infants. Regionalized care enhanced efficiency, demonstrating the value of population-based studies for perinatal program evaluation.
Area of Science:
- Neonatal care
- Perinatal epidemiology
- Longitudinal cohort studies
Background:
- Evaluating regionalized perinatal-neonatal care requires robust population-based follow-up.
- Previous studies often relied on institution-based data, limiting comprehensive outcome assessment.
Purpose of the Study:
- To assess the effectiveness and efficiency of a regionalized perinatal-neonatal care program.
- To evaluate survival and quality-adjusted survival rates in extremely-low-birthweight and extremely-preterm infants over time.
Main Methods:
- Population-based, geographically determined cohort study in Victoria.
- Follow-up of consecutively born infants (<1000g or <28 weeks' gestation) up to 14 years of age.
- Analysis across four distinct time periods (1979-1997) to track trends.
Main Results:
- Significant improvements in both survival and quality-adjusted survival rates were observed across all subgroups.
- Increasing proportion of high-risk infants born in level III perinatal centers correlated with improved outcomes.
- Cost-effectiveness and cost-utility ratios remained stable, with efficiency gains noted in smaller infants.
Conclusions:
- Regionalized, population-based long-term follow-up studies provide critical data for optimizing perinatal-neonatal care programs.
- The study demonstrates the success of regionalized care in improving outcomes for high-risk infants.
- This approach offers unique insights unobtainable from institution-based studies.
Abstract:
The importance of population-based long-term follow-up studies of geographically determined cohorts to evaluate the effectiveness, efficiency and availability of a regionalized perinatal-neonatal care programme is demonstrated by the Victorian Infant Collaborative Study Group. The survival and quality of survival of consecutively born extremely-low-birthweight infants below 1000 g or extremely preterm infants below 28 weeks' gestation in the state of Victoria were assessed up to 14 years of age over four distinctive eras: 1979-1989, 1985-1987, 1991-1992 and 1997. Both survival and quality-adjusted survival rates rose progressively in all birth weight and gestation subgroups, associated with progressively more such infants being born in level III perinatal centres. Cost-effectiveness and cost-utility ratios remained stable overall, with efficiency gains in the smaller infants over time. Regionalized long-term follow-up provides unique information that is not available from institution-based studies, which is vital to the regional organization of perinatal-neonatal care.
