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Active perinatal care of preterm infants in the German Neonatal Network
Alexander Humberg1, Christoph Härtel1, Tanja K Rausch2
1Paediatrics, University of Lübeck, Lübeck, Germany.
Insights
Survival rates for preterm infants receiving active perinatal care have improved, particularly in centers with historically lower survival rates. This progress challenges solely using gestational age for treatment decisions in extremely premature infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Active perinatal care aims to improve outcomes for preterm infants.
- The German Neonatal Network (GNN) is a cohort study tracking preterm infants with birth weights under 1500 grams.
- Previous studies suggest improvements in neonatal intensive care unit (NICU) survival rates over time.
Purpose of the Study:
- To evaluate changes in survival rates of preterm infants (<1500 g) receiving active perinatal care between 2011 and 2016.
- To identify if improvements in survival are linked to specific NICU performance groups.
- To assess the impact of active perinatal care on infants at the border of viability.
Main Methods:
- A retrospective cohort study analyzing data from 8222 preterm infants (gestational age 22-28 weeks) discharged between 2011 and 2016.
- Infants were from 43 German level III neonatal intensive care units (NICUs).
- NICUs were categorized into high, intermediate, and low survival groups based on 2011-2013 data and compared with 2014-2016 outcomes.
Main Results:
- Overall survival increased from 85.8% (2011-2013) to 87.4% (2014-2016).
- The most significant improvements were observed in NICUs with initially low survival rates.
- Survival rates for infants aged 22-24 weeks increased from 53% to 64%, and for 25-26 weeks from 73% to 84% in these lower-performing centers.
Conclusions:
- Active perinatal care demonstrably improves survival rates for very immature infants, especially those near the threshold of viability.
- The observed survival gains challenge national guidelines that rely solely on gestational age for determining active care.
- Further research is needed to refine recommendations for parental counseling regarding active perinatal care decisions.
Objective:
To determine if survival rates of preterm infants receiving active perinatal care improve over time.
Design:
The German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016.
Setting:
43 German level III neonatal intensive care units (NICUs).
Patients:
8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care.
Interventions:
Participating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25-P75) and low (
Main Outcome Measures:
Death by any cause before discharge.
Results:
Total survival increased from 85.8% in 2011-2013 to 87.4% in 2014-2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011-2013. Survival increased in these centres from 53% to 64% in the 22-24 weeks strata and from 73% to 84% in the 25-26 weeks strata.
Conclusions:
Our data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered.
Trial Registration:
Approval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08-022) and by the local ethic committees of all participating centres has been given.
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