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Chronic lung disease following neonatal ventilation. I. incidence in two geographically defined populations
A C Fenton1, G Annich, E Mason
1Department of Child Health, University of Leicester, England.
Insights
Infants born prematurely in British Columbia experienced higher rates of chronic lung disease and required more respiratory support compared to those in England. This occurred despite increased use of antenatal steroids and surfactant therapy in British Columbia.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Public Health
Background:
- Chronic lung disease (CLD) is a significant concern in preterm infants requiring neonatal ventilation.
- Geographical variations in CLD incidence suggest potential differences in care practices or environmental factors.
Purpose of the Study:
- To compare the incidence of chronic lung disease in neonates receiving ventilation between two geographically distinct populations: Trent Health Region, England, and British Columbia, Canada.
- To identify potential factors contributing to observed differences in CLD rates and resource utilization.
Main Methods:
- Prospective data collection over one year (March 1990-February 1991).
- Inclusion criteria: infants born at or before 32 weeks gestation and/or weighing 1500g or less.
- Outcome measures: mortality, CLD incidence, ventilation duration, and oxygen use.
Main Results:
- No significant differences in mean birthweight or gestation between the two cohorts.
- British Columbia showed a trend towards lower mortality for infants weighing 750-1500g.
- Significantly higher incidence of chronic lung disease in British Columbia, requiring greater respiratory care, despite increased use of antenatal steroids and surfactant therapy.
Conclusions:
- Geographical variations exist in chronic lung disease incidence and respiratory care needs among preterm infants.
- Higher CLD rates in British Columbia warrant further investigation into treatment modalities and their impact.
- Findings highlight the clinical and resource implications for planning neonatal services.
Abstract:
The objective of this study was to compare the incidence of chronic lung disease following neonatal ventilation in two geographically defined populations. Prospective data collection was carried out over a 1 year period from March 11, 1990 to February 28, 1991 in the Trent Health Region (England) and in British Columbia, Canada. All infants < or = 32 weeks gestation and/or < or = 1500 g birthweight born to mothers normally resident in either the Trent Health Region or British Columbia were included. The main outcome measures were mortality rate, presence of chronic lung disease, days of ventilation, and oxygen used by each infant. The proportion of shortened gestation, low birthweight babies was 1.5% in Trent and 1.2% in British Columbia (957 of 63,350 births in Trent and 526 of 45,333 births in British Columbia). There were no significant differences in mean birthweight or gestation between the two cohorts, but there was a trend towards lower mortality for infants 750-1500 g birthweight in British Columbia. The incidence of chronic lung disease (using either of two definitions) was significantly higher in British Columbia, with a corresponding greater amount of respiratory care required. This occurred despite higher use of antenatal steroids and surfactant therapy in the British Columbia group. We conclude that there are important clinical and resource implications resulting from the number of ventilator and oxygen days used by the preterm population in terms of planning of neonatal services. The role of individual treatment modalities in producing differences in the incidence of chronic lung disease warrants further study in the setting of a geographically defined population.