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Published on: December 31, 2015
Population-based trends in mortality and neonatal morbidities among singleton, very preterm, very low birth weight
Sorina Grisaru-Granovsky1, Brian Reichman2, Liat Lerner-Geva2
1Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem.
Insights
Improved survival for very preterm, very low birth weight infants did not increase neurological morbidities. However, bronchopulmonary dysplasia remains a significant concern, requiring targeted interventions.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Improved survival rates for singleton very preterm, very low birth weight (VPT-VLBW) infants have been observed.
- This improved survival has raised concerns about a potential increase in severe neonatal morbidities.
Purpose of the Study:
- To evaluate trends in mortality and major neonatal morbidities among singleton VPT-VLBW infants.
- To determine if increased survival is associated with a higher incidence of neurological complications.
Main Methods:
- A population-based observational study utilizing data from the Israel Neonatal Network.
- Analysis of 10,705 singleton VPT-VLBW infants born between 24-32 gestational weeks from 1995-2010.
- Assessment of mortality and major neonatal morbidities (including neurological complications and bronchopulmonary dysplasia) across three time periods: 1995-2000, 2001-2005, and 2006-2010.
Main Results:
- Mortality rates significantly decreased from 20.2% to 13.8% over the study period.
- The incidence of major neurological morbidities among surviving infants decreased from 16.4% to 12.8%.
- While neurological outcomes improved, bronchopulmonary dysplasia rates remained a considerable challenge.
Conclusions:
- Increased survival of singleton VPT-VLBW infants is not linked to a higher risk of major neonatal neurological morbidities.
- Bronchopulmonary dysplasia continues to represent a significant burden for this population.
- Future research and clinical efforts should focus on preventing and treating respiratory complications in preterm infants.
Background:
Improved survival of singleton very preterm, very low birth weight (VPTVLBW) infants has been associated with increasing rates of severe neonatal morbidities.
Aim:
To assess changes in mortality and neonatal morbidities among singleton VPT-VLBW infants.
Study Design:
Population-based observational study of data collected by the Israel Neonatal Network.
Subjects:
10,705 singleton VPT-VLBW infants born at 24-32 gestational weeks in 1995-2010.
Outcome Measures:
Mortality and major neonatal morbidities over 3 time periods: 1995-2000, 2001-2005, and 2006-2010. Major neurological morbidities comprised intraventricular hemorrhage grades 3-4, periventricular leukomalacia and retinopathy of prematurity grades 3-4.
Results:
The mortality rate decreased over time from 20.2% to 13.8% for all birth weight and gestational age groups. Compared to the 1995-2000 period, the adjusted odds ratios (aORs) (95% confidence intervals,) for mortality in 2001-2005 and 2006-2010 were 0.78 (0.67-0.90) and 0.72 (0.62-0.84), respectively. The combined outcomes of death or major neurological morbidities, aOR 0.74 (0.65-0.84) and death or major neurological morbidities and/or bronchopulmonary dysplasia aOR 0.85 (0.75-0.96) decreased significantly between the first and last periods. A significant improvement in mortality rates and survival without one or more major neonatal morbidity was observed for all birth weight and gestational age groups. Among 8,886 surviving infants the rates of major neurological morbidities decreased from 16.4% to 12.8%, aOR 0.80 (0.68-0.95).
Conclusion:
The improving survival of singleton VTP-VLBW infants was not associated with a concomitant increase in the risk for major neonatal neurological morbidities among surviving infants. Bronchopulmonary dysplasia, however, remained a significant burden. This analysis emphasizes the need to direct efforts towards the prevention and treatment of adverse respiratory sequelae.
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