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Published on: September 6, 2017
Population-Based Outcome Data of Extremely Preterm Infants in Germany during 2010-2017
Christoph Bührer1, Günther Heller2, Ulrich H Thome3
1Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Insights
Mortality in extremely preterm infants declined moderately between 2010-2017. While severe retinopathy of prematurity (ROP) saw a slight increase, bronchopulmonary dysplasia (BPD) rates steadily decreased, potentially due to reduced intubation.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Public Health
Background:
- Randomized controlled trials (RCTs) published 2010-2015 suggested higher oxygen saturation targets increased severe retinopathy of prematurity (ROP) while lowering mortality in preterm infants.
- Minimally invasive surfactant administration avoiding endotracheal intubation was shown to reduce respiratory morbidity.
Purpose of the Study:
- To analyze population-level outcomes in extremely preterm infants born in Germany between 2010 and 2017.
- To assess changes in mortality and major morbidities in relation to evolving clinical practices.
Main Methods:
- Utilized mandatory German quality surveillance data.
- Compared outcomes for infants born between 24 weeks 0 days and 27 weeks 6 days of gestation in two periods: 2010-2013 and 2014-2017.
Main Results:
- Overall mortality decreased from 15.1% to 12.7% (RR 0.845).
- Rates of severe ROP (≥grade 3) per survivor increased slightly from 12.1% to 13.3% (RR 1.100).
- Rates of bronchopulmonary dysplasia (BPD) decreased steadily from 2010-2017, coinciding with an increased proportion of infants never intubated.
Conclusions:
- A moderate decline in mortality and a steady decline in BPD were observed in Germany from 2010-2017.
- An insignificant increase in severe ROP rates was noted.
- Reduced endotracheal intubation may have contributed to the observed decrease in BPD rates.
Background And Objective:
Results of five randomized controlled trials (RCT) sequentially published in 2010-2013 suggested that aiming for higher, as opposed to lower oxygen saturation targets, reduces rates of mortality in infants <28 weeks of gestation, while increasing rates of severe retinopathy of prematurity (ROP). Two further RCTs published in 2011 and 2015 demonstrated that avoiding endotracheal intubation by minimally invasive surfactant administration reduces respiratory morbidity. Assuming that such data are likely to affect clinical practice and ultimate outcome, we analyzed population-level results in extremely preterm infants born across Germany during 2010-2017.
Methods:
We used mandatory German quality surveillance data to compare mortality and morbidities in preterm infants born between 24 weeks 0 days and 27 weeks 6 days of gestation in 2010-2013 versus 2014-2017.
Results:
Mortality decreased from 15.1% (1,366/9,058) in 2010-2013 to 12.7% (1,385/10,924) in 2014-2017, risk ratio (RR) 0.845 (95% confidence interval [CI], 0.784-0.901). Rates of severe ROP (≥grade 3) per survivor increased from 12.1% (930/7,692) to 13.3% (1.269/9,539), RR 1.100 (95% CI: 1.017-1.191). The lowest mortality and highest ROP rates were found in infants born in 2014. There was no change in rates of necrotizing enterocolitis, while those of bronchopulmonary dysplasia (BPD) decreased steadily between 2010 and 2017, alongside the increased proportion of infants who were never intubated.
Conclusions:
There was a moderate decline in mortality, an insignificant increase in severe ROP, and a steady decline of BPD in Germany during 2010-2017. Avoiding endotracheal intubation may have contributed to lowered BPD rates.
