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Lower mortality but higher neonatal morbidity over a decade in very preterm infants

Martin J K de Kleine1, A Lya den Ouden, Louis A A Kollée

  • 1Department of Neonatology, Máxima Medical Centre, 5500 MD Veldhoven, The Netherlands. m.dekleine@mmc.ne

Paediatric and Perinatal Epidemiology
|January 24, 2007
PubMed

Insights

Improved perinatal care increased survival for very preterm infants, but also led to more cases of intraventricular hemorrhage and bronchopulmonary dysplasia (BPD). This study examines outcomes over a decade, highlighting key risk factors and changes in infant morbidity.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Pediatric Critical Care

Background:

  • Advances in perinatal care have improved survival rates for very preterm infants.
  • However, the impact of these advancements on the incidence of cerebral and pulmonary morbidities remains unclear.

Purpose of the Study:

  • To investigate the relationship between changes in perinatal care over a decade and the short-term outcomes of very preterm infants.
  • To compare perinatal risk factors and their effects on mortality and morbidities between two distinct survey periods.

Main Methods:

  • Two surveys of very preterm singleton infants in the Netherlands were conducted, comparing data from 1983 and 1993.
  • Analysis focused on 28-day mortality, in-hospital mortality, intraventricular hemorrhage (IVH), and bronchopulmonary dysplasia (BPD) in survivors.
  • Multivariable analysis was used to identify risk factors associated with mortality and morbidities.

Main Results:

  • 28-day mortality significantly decreased for infants aged 25-27 and 28-31 weeks' gestation between 1983 and 1993.
  • The incidence of IVH in survivors remained unchanged, while the incidence of BPD increased significantly in infants aged 25-27 weeks' gestation.
  • Key mortality risk factors included congenital malformations, low gestational age, low birthweight, lack of antenatal steroids, low Apgar scores, and IVH. The effect of maternal age on mortality diminished over time.

Conclusions:

  • Improved survival for very preterm infants, particularly those born at 25-27 weeks' gestation, has been accompanied by a similar incidence of IVH and an increased incidence of BPD.
  • Artificial ventilation and low gestational age were consistently associated with IVH and BPD, though the effect of ventilation on IVH incidence decreased.
  • Low birthweight and cesarean section emerged as risk factors for BPD in 1993.

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