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Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009
Roger F Soll1, Erika M Edwards, Gary J Badger
1Department of Pediatrics, University of Vermont, Burlington, Vermont 05401, USA. roger.soll@vtmednet.org
Insights
Clinical practices for low birth weight infants (501-1500g) significantly evolved between 2000-2009, with increased use of less-invasive respiratory support. These changes highlight advancements in neonatal care for vulnerable newborns.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Critical Care
Background:
- Infants born with birth weights between 501 to 1500 grams represent a vulnerable population requiring specialized medical care.
- Clinical practices in neonatal intensive care units (NICUs) are continually evolving to improve outcomes for these infants.
Purpose of the Study:
- To identify and analyze changes in clinical practices for infants with birth weights of 501 to 1500 grams.
- To track trends in obstetric and neonatal interventions and care from 2000 to 2009.
Main Methods:
- Utilized prospectively collected registry data from 355,806 infants born between 2000 and 2009.
- Data sourced from 669 North American hospitals within the Vermont Oxford Network.
- Assessed changes in obstetric and neonatal practices, including delivery interventions, respiratory support, neuroimaging, and feeding.
Main Results:
- Significant shifts in obstetric and neonatal practices were observed from 2000 to 2009.
- Increased use of surfactant treatment in the delivery room and less-invasive respiratory support like nasal continuous positive airway pressure.
- Decreased use of ventilation and steroids for chronic lung disease, with most changes consistent across birth weight strata.
Conclusions:
- Obstetric and neonatal care practices for infants weighing 501 to 1500 grams underwent substantial changes between 2000 and 2009.
- A notable trend towards less-invasive respiratory support strategies was identified.
Objective:
To identify changes in clinical practices for infants with birth weights of 501 to 1500 g born from 2000 to 2009.
Methods:
We used prospectively collected registry data for 355,806 infants born from 2000 to 2009 and cared for at 669 North American hospitals in the Vermont Oxford Network. Main outcome measures included obstetric and neonatal practices, including cesarean delivery, antenatal steroids, delivery room interventions, respiratory practices, neuroimaging, retinal exams, and feeding at discharge.
Results:
Significant changes in many obstetric, delivery room, and neonatal practices occurred from 2000 to 2009. Use of surfactant treatment in the delivery room increased overall (adjusted difference [AD] 17.0%; 95% confidence interval [CI] 16.4% to 17.6%), as did less-invasive methods of respiratory support, such as nasal continuous positive airway pressure (AD 9.9%; 95% CI 9.1% to 10.6%). Use of any ventilation (AD -7.5%; 95% CI -8.0% to -6.9%) and steroids for chronic lung disease (AD -15.3%; 95% CI -15.8% to -14.8%) decreased significantly overall. Most of the changes in respiratory care were observed within each of 4 birth weight strata (501-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g).
Conclusions:
Many obstetric and neonatal care practices used in the management of infants 501 to 1500 g changed between 2000 and 2009. In particular, less-invasive approaches to respiratory support increased.
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