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[THE ISRAEL NATIONAL VERY LOW BIRTH WEIGHT INFANT DATABASE]
Insights
Outcomes for very low birth weight (VLBW) infants have significantly improved in Israel. Mortality and major neonatal morbidities, including sepsis and retinopathy of prematurity, have decreased substantially since 1995.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Context:
- Very low birth weight (VLBW) infants (<1,500g) constitute a small percentage of births but account for a disproportionate share of infant mortality and neonatal intensive care unit (NICU) resource utilization.
- Israel has established a comprehensive national database for VLBW infants since 1995, capturing data from over 99% of these high-risk neonates across all 27 NICUs.
Purpose:
- To identify key perinatal and neonatal factors influencing mortality, morbidity, and long-term handicap in VLBW infants.
- To track trends and evaluate the effectiveness of interventions and care practices for VLBW infants over time.
Summary:
- The Israel national VLBW infant database includes over 25,800 infants born between 1995 and 2011.
- Significant improvements observed include a decline in VLBW infant mortality from 23.7% to 16.8% and reductions in major neonatal morbidities such as late-onset sepsis, severe retinopathy of prematurity, and periventricular leukomalacia.
- While the rate of bronchopulmonary dysplasia showed an initial increase, it subsequently declined.
Impact:
- The findings demonstrate a significant positive trend in VLBW infant outcomes, highlighting the success of national data collection and quality improvement initiatives.
- The study underscores the association between reduced mortality and decreased incidence of major neonatal morbidities, providing valuable insights for clinical practice and policy development in neonatal care.
Background:
Very low birth weight (VLBW ≤ 1,500g] infants represent approximately 1% of all live births in Israel but are responsible for about 45% of all infant deaths and account for 45% of all hospitalization days in the neonatal special and intensive care units (NICU's).
Aim:
To identify perinatal and neonatal factors associated with mortality, morbidity and handicap among VLBW infants.
Methods:
Since 1995 data for > 99% of VLBW infants were received from all 27 NICU's in Israel. The data includes maternal obstetric history, infant's status at birth, deaths, major neonatal morbidities and treatments during the infant's hospitalization. The data are analyzed, collated and annual national and departmental reports prepared.
Results:
The database comprises information on 25,800 VLBW infants born from 1995-2011. Approximately 20% of VLBW infants were conceived by in-vitro fertilization, one-third of the births were multiple births and 60% of multiple births were the result of infertility treatments. Mortality declined significantly from 23.7% in 1995-1997 to 16.8% in 2010-2011. During this period significant decreases in major neonatal morbidities were documented: Late onset sepsis (> 3 days) decreased from 29.9% to 23.2% in 2010-2011; severe retinopathy of prematurity from 7.6% to 3.8% and periventricular leukomalacia from 8.3% to 5.0%. The rate of bronchopulmonary dysplasia increased from 9.5% in 1995-1997 to 13% in the period 2001-2006, subsequently declining to 10.8% in the last years.
Conclusion:
Since 1995 the Israel national VLBW infant database has provided information at both national and hospital levels, documenting the improving care and outcomes for VLBW infants. The significant decline in VLBW infant mortality has been associated with a parallel decrease in major neonatal morbidities.