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Morbidity and mortality of very low birth weight infants in Taiwan-Changes in 15 years: A population based study
Yi-Yu Su1, Shih-Hsin Wang2, Hung-Chieh Chou3
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
Insights
Mortality and most morbidities in very low birth weight (VLBW) infants improved in Taiwan from 1997-2011. However, the incidence of retinopathy of prematurity (ROP) remained constant, necessitating further prevention strategies.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Very low birth weight (VLBW) infants represent over 50% of perinatal deaths in Taiwan.
- Understanding trends in VLBW infant outcomes is crucial for improving care.
Purpose of the Study:
- To analyze changes in parental characteristics and perinatal conditions for VLBW infants in Taiwan.
- To identify trends in mortality and major neonatal morbidities among VLBW infants.
- To highlight challenges for patients, families, and caregivers of VLBW infants.
Main Methods:
- Retrospective cohort study of 13,159 VLBW infants from the Taiwan Premature Infant Follow-up Network (1997-2011).
- Exclusion of infants with congenital or chromosome anomalies.
- Statistical analysis using one-way ANOVA to assess changes over time (p < 0.05).
Main Results:
- Increased parental age, education, and use of in vitro fertilization, cesarean sections, and antenatal steroids.
- Improved Apgar scores and decreased intubation rates.
- Decreased overall mortality; increased rates of respiratory distress syndrome and patent ductus arteriosus; decreased rates of sepsis, necrotizing enterocolitis, intraventricular hemorrhage, and chronic lung disease.
- Constant incidence of retinopathy of prematurity (ROP).
Conclusions:
- While VLBW infant mortality and most morbidities have improved, ROP incidence remains a persistent challenge.
- Current strategies for ROP prevention in VLBW infants require re-evaluation.
- Further research is needed to address the constant ROP incidence in this vulnerable population.
Background/Purpose:
Very low birth weight (VLBW) infants account for over 50% of perinatal deaths in Taiwan. This study aimed to identify changes in parental characteristics, perinatal conditions, mortality, and major neonatal morbidities for VLBW infants in Taiwan, and to highlight the challenges faced by patients, families, and caregivers.
Methods:
We conducted a retrospective cohort study to investigate the mortality and morbidity of VLBW infants registered in the Taiwan Premature Infant Follow-up Network from 1997 through 2011. The exclusion criteria included congenital anomalies and chromosome anomalies. Continuous data was represented as mean ± SD, and changes over time in the variables were tested using one-way analysis of variance, with p < 0.05 considered statistically significant.
Results:
A total of 13,159 VLBW infants were enrolled. We found significant increases over time in the parental age and educational level, in vitro fertilization, first livebirth, multiple births, maternal transfer, cesarean section, and complete antenatal steroid use. Apgar scores at 1 minute and 5 minutes after birth increased, and the intubation rate decreased gradually. Decreasing mortality over time for each successive period was demonstrated. Incidence of some morbidities increased, such as respiratory distress syndrome and patent ductus arteriosus; in contrast, incidence of others decreased, such as sepsis, necrotizing enterocolitis, intraventricular hemorrhage, and chronic lung disease. However, retinopathy of prematurity (ROP) incidence remained constant.
Conclusion:
Although the mortality and most of the morbidity of VLBW infants improved over time, the incidence of ROP remained constant. This requires us to further evaluate our strategy for preventing ROP in the future.
