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Neonatal morbi-mortality in very low birth weight in Europe: the Portuguese experience
Teresa Tomé1, H Guimarães, A Bettencourt
1Maternidade Dr. Alfredo da Costa, Department of Neonatology, Lisbon, Portugal. teresatome@netcabo.pt
Insights
Portugal
Area of Science:
- Neonatalogy
- Public Health Policy
- Perinatal Care
Background:
- Regionalization of care for very low birth weight (VLBW) infants was implemented in Portugal.
- Assessing the impact of this policy on infant outcomes is crucial.
Purpose of the Study:
- To evaluate the evolution of care for very low birth weight (VLBW) infants.
- To analyze mortality, morbidity, and the quality of regionalization in Portugal.
Main Methods:
- Analysis of data from the National Portuguese Network of VLBW infants.
- Inclusion of 12,826 VLBW infants born between January 1994 and December 2008.
Main Results:
- Global mortality for VLBW infants was 11%.
- Significant survival improvements observed in infants over 1000g.
- Increased number of VLBW infants born in appropriate facilities due to enhanced regionalization.
- Neonatal mortality rate improvements positively impacted perinatal and infant mortalities.
Conclusions:
- Reinforced regionalization policies led to improved mortality rates for VLBW infants.
- The study demonstrates the successful achievement of regionalization aims in Portugal.
- Effective perinatal care reform relies on accurate diagnosis, appropriate strategies, and political commitment.
Abstract:
The aim of this study was to access evolution in care of very low birth weight (VLBW) infants after the implementation of a regionalization policy in Portugal. The data of the National Portuguese Network of VLBW infants are analyzed concerning mortality, morbidity, and quality of regionalization. A total of 12,826 VLBW infants born from 1 January 1994 to 31 December 2008 were enrolled, with a prevalence of 0.66%-0.99% of all live born. The global mortality was 11%. The major improvement in survival is in the babies more than 1000 g. Since 2004, the threshold of viability is 25 weeks, but the intact survival is around 28 weeks. In the last 10 years with more efficient regionalization more VLBW babies are born in the right place. The improvement in neonatal mortality rate was determinant in the good evolution of perinatal and infant mortalities. After reinforcement of regionalization policies, we found improvements in mortality for VLBW infants. The aims of regionalization were achieved. The reform of perinatal care in Portugal is an example of how a good diagnosis and adequate proposals combined with a strong political will is crucial for changing.
