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Mortality with increasing assisted ventilation of very-low-birth-weight infants
L W Doyle1, L J Murton, W H Kitchen
1Department of Obstetrics and Gynaecology and Paediatrics, University of Melbourne, Parkville, Australia.
Insights
Increased use of assisted ventilation for very-low-birth-weight (VLBW) infants did not improve overall survival. While mortality decreased in the smallest VLBW infants, it unexpectedly rose in larger VLBW infants.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Respiratory Support
Background:
- Very-low-birth-weight (VLBW) infants are high consumers of intensive care resources.
- Assisted ventilation is a critical intervention for VLBW infants facing respiratory distress.
Purpose of the Study:
- To evaluate the impact of increased assisted ventilation resource utilization on VLBW infant outcomes.
- To analyze mortality trends in VLBW infants stratified by birth weight during a decade of changing ventilation practices.
Main Methods:
- Retrospective analysis of VLBW infant data from a tertiary perinatal center over a 10-year period (1977-1987).
- Comparison of assisted ventilation consumption and mortality rates between two 5-year periods.
- Stratification of VLBW infants by birth weight (<1200g and 1200-1499g) to assess differential outcomes.
Main Results:
- Assisted ventilation patient-days per live birth increased by nearly 60% in the second five-year period.
- Mortality decreased in VLBW infants <1200g.
- Mortality unexpectedly increased in VLBW infants weighing 1200-1499g (OR 3.11).
Conclusions:
- Increased provision of assisted ventilation for VLBW infants did not lead to a significant reduction in overall mortality.
- Differential effects of assisted ventilation were observed, with adverse outcomes in larger VLBW infants despite increased resource allocation.
Abstract:
From Jan 1, 1977, to Jan 1, 1987, very-low-birth-weight (VLBW) infants consumed almost 90% of total patient-days of assisted ventilation of all infants born in one tertiary perinatal center. In the latter five years compared with the first five years, increasing resources allowed proportionately more VLBW infants to be offered assisted ventilation, and the patient-days of assisted ventilation consumed per live birth rose by almost 60%. All VLBW infants did not benefit equally from the increased assisted ventilation. Mortality in infants with birth weights below 1200 g decreased; unexpectedly, mortality in larger VLBW infants (birth weights, 1200 g to 1499 g) rose (relative odds, 3.11; 95% confidence intervals, 1.21 to 7.99). Despite the increased consumption of ventilator resources, there was no substantial impact on overall mortality in VLBW infants.