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Population based age stratified morbidities of premature infants in Switzerland
Nadia M Bajwa1, Michel Berner, Sarah Worley
1Department of Neonatology, Hôpital des Enfants, Hôpitaux Universitaires de Genève, Switzerland. nadia.bajwa@hcuge.ch
Insights
Infant mortality and major complications significantly decrease with each week of increased gestational age (GA). This data is crucial for prenatal counseling regarding outcomes for premature infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Premature infants face significant risks of mortality and serious health issues.
- Accurate incidence data stratified by gestational age is essential for clinical decision-making and parental counseling.
Purpose of the Study:
- To determine population-based incidence rates of mortality and major morbidities in preterm infants.
- To stratify these outcomes by gestational age (GA).
Main Methods:
- A prospective, population-based observational study was conducted in Swiss neonatal intensive care units.
- Infants born between 23 and 31 weeks GA between 2000-2004 were included.
- Outcomes measured included mortality, severe intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and survival free of major complications.
Main Results:
- Overall mortality was 19% in 3083 infants, decreasing from 95% at 23 weeks GA to 3% at 31 weeks GA.
- Survival free of major complications increased from 2% at 23 weeks to 89% at 31 weeks GA.
- Incidence rates were: IVH 8%, PVL 2%, NEC 3%, and BPD 11%. Antenatal steroid use was associated with lower mortality and IVH.
Conclusions:
- Mortality and most major morbidities decline weekly with increasing gestational age, with PVL being an exception.
- Gestational age-stratified data are critical for effective prenatal counseling for expected preterm births.
Objective:
To provide population-based, gestational age (GA) stratified incidence of mortality and morbidities.
Methods:
Population-based prospective observational study of infants born between 23 0/7 and 31 6/7 weeks GA in the years 2000-2004 in all Swiss neonatal intensive care units. Outcomes measured were: mortality, severe intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), moderate/severe bronchopulmonary dysplasia (BPD) and free of major complications.
Results:
Mortality was 19% of 3083 infants. Mortality (95% CI) decreased from 95% (88%, 99%) at 23 weeks to 3% (2%, 5%) at 31 weeks. Short-term survival free of major complications was 66% (65%, 68%) overall and increased from 2%(0%, 9%) to 89% (87%, 92%). Rate of IVH was 8% (7%, 9%), PVL 2% (2%, 3%), NEC 3% (3%, 4%) and BPD 11% (10%, 12%). Males had more IVH than females (9% vs. 6%). Antenatal steroids were associated with lower mortality (11% vs. 18%) and IVH (5% vs. 12%). Odds of free of major complications (OR, 95%CI) were positive for female gender 1.2 (1.0, 1.5), steroids 1.3 (1.1, 1.5), multiple gestation 1.3 (1.0, 1.6), not small for gestational age 2.7 (2.0, 3.5), and each additional week of GA 1.6 (1.5, 1.7).
Conclusion:
Mortality and incidence of morbidities known to influence outcome show a weekly decline with increasing gestational age, except for PVL. Gestational age stratified data are a key component for prenatal counselling.
