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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

[Effectiveness assessment of a neonatal intensive care program for very low birth weight infants. Impact of

Carlos A Fustiñana1, Gustavo Izbizky, Diana Rodríguez

  • 1Servicio de Neonatología, Departamento de Pediatría, Hospital Italiano, Buenos Aires. carlos.fustinana@hospitalitaliano.org.ar

Archivos Argentinos De Pediatria
|April 8, 2009
PubMed

Insights

Neonatal intensive care for very low birth weight infants (VLBWI) significantly improved survival rates and quality of survival after surfactant introduction. These advancements were most pronounced in infants weighing less than 1000 grams.

Area of Science:

  • Neonatology
  • Pediatric Critical Care
  • Perinatal Medicine

Background:

  • Therapeutic interventions in Neonatal Intensive Care Units (NICU) for Very Low Birth Weight Infants (VLBWI) have demonstrated efficacy in randomized control trials (RCT).
  • However, questions persist regarding the overall effectiveness and quality of survival in VLBWI over time.
  • Changes in NICU practices, particularly the introduction of surfactant, warrant investigation into their impact on neonatal survival outcomes.

Purpose of the Study:

  • To evaluate the changes in the effectiveness of NICU practices on the quality of neonatal survival for VLBWI over a 14-year period.
  • To specifically assess the impact of surfactant introduction on reanimation practices and survival outcomes in VLBWI.
  • To analyze trends in survival rates, quality of survival (life-years gained), and NICU length of stay across different weight categories.

Main Methods:

  • A retrospective study included all consecutive VLBWI admitted to the NICU between 1989-1992 (n=145) and 1993-2002 (n=342).
  • Patients were categorized into four weight groups (500-1500g).
  • Survival, quality of survival (QS) measured in life-years gained, and NICU length of stay were analyzed, with 80-85% of survivors assessed at two years of corrected age.

Main Results:

  • The overall survival rate for VLBWI significantly improved from 52% to 75% between the two periods (a 23% increase).
  • Actuarial survival showed significant increases across all weight groups (p <0.001), with a notable rise from 4% to 33% in the 500-749g group.
  • Life-years gained significantly increased for infants <750g and 750-999g, while NICU stay increased for the <750g group and decreased for the >=1250g group.

Conclusions:

  • Neonatal intensive care for VLBWI has become more effective following the introduction of surfactant therapy in the 1993-2002 period.
  • The improvements in survival and quality of survival were particularly significant for infants weighing less than 1000 grams.
  • These findings underscore the critical role of surfactant therapy in enhancing outcomes for extremely preterm infants.
Abstract

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