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Changes in care and short-term outcome for very preterm infants in Estonia
Liis Toome1, Inge Ringmets, Pille Andresson
1Department of Paediatrics, University of Tartu, Tartu, Estonia. liis.toome@lastehaigla.ee
Insights
Outcomes for very preterm infants in Estonia improved, with increased survival rates and proactive perinatal care. Neonatal care became less invasive, reducing severe brain bleeds without extending hospital stays.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Background:
- Estonia has a history of tracking very preterm infant outcomes.
- Changes in perinatal care practices may impact infant survival and morbidity.
Purpose of the Study:
- To assess recent trends in short-term outcomes and care for very preterm infants in Estonia.
- To compare outcomes between two distinct birth cohorts.
Main Methods:
- Population-based cohort study comparing infants born in 2002-2003 and 2007-2008.
- Data collected retrospectively and prospectively from neonatal registers and hospital records.
- Infants born at 22-31 gestational weeks were followed until discharge or death.
Main Results:
- The 2007-2008 cohort showed increased use of cesarean sections, antenatal corticosteroids, maternal antibiotics, and surfactant therapy.
- Survival to discharge improved significantly (85% vs. 78%, p=0.041) with no change in hospital stay length.
- Mechanical ventilation, inotropes, and postnatal antibiotic use decreased, as did severe periventricular/intraventricular hemorrhage.
Conclusions:
- Very preterm infant outcomes in Estonia have improved since 2002.
- Proactive perinatal management and less invasive neonatal care contributed to increased survival.
- Improved outcomes were achieved without increasing neonatal morbidity or hospital length of stay.
Aim:
To identify recent changes in short-term outcome and care for very preterm infants in Estonia.
Methods:
Comparison of two population-based cohort of very preterm infants born alive at 22-31 gestational weeks. In 2007-2008, data were recorded prospectively in a neonatal register. For the cohort born in 2002-2003, the same variables were extracted retrospectively from the hospital records. Infants were followed up to discharge or death.
Results:
The cohort of 2007-2008 contained a higher proportion of infants born by caesarean section and of infants who received antenatal corticosteroids, maternal antibiotics, or surfactant therapy than the earlier cohort. A higher proportion of infants was admitted for care in 2007-2008 (98% vs. 94%; p = 0.013). During the study period, survival until discharge increased (85% vs. 78%; p = 0.041), although the length of hospital stay was unchanged. The use of mechanical ventilation, inotropes, and postnatal antibiotics decreased. Neonatal morbidity remained unchanged, except for a decrease in severe periventricular/intraventricular haemorrhage.
Conclusion:
The outcome for very preterm infants in Estonia has improved since 2002. With proactive perinatal management and less invasive neonatal care, survival until discharge increased without concomitant increases in neonatal morbidity and the length of hospital stay.
