Mortality and Major Morbidity of Very-Low-Birth-Weight Infants in Germany 2008-2012: A Report Based on Administrative Data
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Published on: May 23, 2011
Elke Jeschke1, Alexandra Biermann1, Christian Günster1
1Wissenschaftliches Institut der Ortskrankenkassen , Berlin , Germany.
Insights
Survival rates for very preterm infants vary significantly by birth weight, with higher weights correlating to better outcomes. Administrative data can effectively track survival and major morbidities in these vulnerable infants.
Area of Science:
- Neonatalogy
- Public Health
- Medical Informatics
Background:
- Estimates for survival and morbidity in very preterm infants are crucial for parents, physicians, and policymakers.
- Such data should be derived from large, reliable, and contemporary databases using readily available information at birth.
Purpose of the Study:
- To determine short-term outcomes and identify risk factors in very-low-birth-weight preterm infants using administrative data.
- To assess survival probabilities and rates of survival free of major morbidities based on birth weight categories.
Main Methods:
- Utilized anonymized routine data sets from hospital administrations and statutory health insurance companies in Germany.
- Analyzed a large cohort of 13,147 preterm infants (birth weight < 1,500g) admitted to neonatal care between 2008-2012.
- Excluded infants with lethal malformations prior to analysis.
Main Results:
- Overall mortality within 180 days was 10.9% (1,432 infants).
- 180-day survival probabilities ranged from 0.632 (250-499g) to 0.985 (1,250-1,499g).
- Survival without major morbidities (IVH, NEC, intestinal perforation, retinopathy) ranged from 0.433 (250-499g) to 0.969 (1,250-1,499g).
- Adding sex, small for gestational age, and congenital malformations moderately improved outcome prediction.
Conclusions:
- Administrative data are a valuable resource for investigating risk factors and outcomes in preterm infants.
- The findings provide essential data for clinical decision-making and public health policy regarding very preterm infants.
Background:
Expectant parents of very preterm infants, physicians, and policy makers require estimates for chances of survival and survival without morbidity. Such estimates should derive from a large, reliable, and contemporary data base of easily available items known at birth.
Objective:
To determine short-term outcome and risk factors in very-low-birth-weight preterm infants based on administrative data.
Methods:
Anonymized routine data sets transmitted from hospital administrations to statutory health insurance companies were used to assess survival and survival free of major morbidities in a large cohort of preterm infants in Germany.
Results:
After exclusion of infants with lethal malformations, there were 13,147 infants with a birth weight below 1,500 g admitted to neonatal care 2008-2012, of whom 1,432 infants (10.9%) died within 180 days. Estimated 180 days survival probabilities were 0.632 (95% confidence interval 0.583-0.677) for infants with 250-499 g birth weight, 0.817 (0.799-0.834) for 500-749 g, 0.931 (0.920-0.940) for 750-999 g, 0.973 (0.967-0.979) for 1,000-1,249 g, and 0.985 (0.981-0.988) for 1,250-1,499 g. Estimated probabilities for survival without major morbidity (surgically treated intraventricular hemorrhage, necrotizing enterocolitis, intestinal perforation, or retinopathy) were 0.433 (0.384-0.481) for 250-499 g, 0.622 (0.600-0.643) for 500-749 g, 0.836 (0.821-0.849) for 750-999 g, 0.938 (0.928-0.946) for 1,000-1,249 g, and 0.969 (0.964-0.974) for 1,250-1,499 g, respectively. Prediction of survival and survival without major morbidities was moderately improved by adding sex, small for gestational age, and severe or moderate congenital malformation, increasing receiver operating characteristic areas under the curve from 0.839 (0.827-0.850) to 0.862 (0.852-0.874) (survival) and from 0.827 (0.822-0.842) to 0.852 (0.846-0.863) (survival without major morbidities), respectively.
Conclusion:
The present analysis encourages attempts to use administrative data to investigate the association between risk factors and outcome in preterm infants.
