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Chronic lung disease following neonatal ventilation. II. Changing incidence in a geographically defined population
A C Fenton1, E Mason, M Clarke
1Department of Child Health, University of Leicester, England.
Insights
Neonatal ventilation improved survival for some premature infants but increased chronic lung disease incidence. Surfactant therapy, while beneficial for survival, did not lead to expected cost savings due to increased respiratory care needs.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Public Health
Background:
- Neonatal ventilation is crucial for premature infants but may increase the risk of chronic lung disease.
- Surfactant therapy has improved survival rates in neonates.
- Understanding trends in chronic lung disease incidence is vital for optimizing neonatal care.
Purpose of the Study:
- To analyze changes in chronic lung disease incidence after neonatal ventilation.
- To evaluate the impact of improved neonatal care on infant mortality and morbidity.
- To identify key factors influencing chronic lung disease development in preterm infants.
Main Methods:
- Prospective data collection over two distinct 1-year periods (1987-1988 and 1990-1991).
- Inclusion criteria: infants ≤32 weeks gestation and/or ≤1500g birthweight.
- Outcome measures: mortality, chronic lung disease, ventilation duration, and oxygen use.
Main Results:
- A significant decrease in mortality was observed for infants weighing 750-1500g.
- The incidence of chronic lung disease significantly increased between the two study periods.
- Infant birthweight and gestational age were identified as critical factors for chronic lung disease development.
Conclusions:
- Improvements in neonatal care, including surfactant therapy, enhanced infant survival.
- Increased survival came at the cost of a higher incidence of chronic lung disease and greater respiratory support needs.
- The anticipated cost savings from surfactant therapy were not realized due to increased care requirements.
Abstract:
The objective of this study was to examine the change in incidence of chronic lung disease following neonatal ventilation in a geographically defined population. Prospective data were collected over two 1-year periods (1987-1988 and 1990-1991) in the Trent Health Region, England. All infants were < or = 32 weeks gestation and/or < or = 1500g birthweight, born to mothers normally resident in the Trent Health Region. The principal outcome measures were mortality rate, presence of chronic lung disease, days of ventilation, and oxygen used by each infant. The proportion of low gestation, low birthweight babies was 1.5% in each period, made up of 897 and 925 babies from 61,050 and 63,350 births, respectively. There was a significant fall in mortality in infants of 750-1500g birthweight. However, the incidence of chronic lung disease (using either of two definitions) rose significantly between the two periods, with a corresponding large rise in the amount of respiratory care required. The contribution of various antenatal factors previously thought to be related to the development of chronic lung disease was examined. Birthweight and gestation were shown to be of overwhelming significance. We concluded that improvements in neonatal care, including the introduction of surfactant therapy, improved survival for some infants at the expense of an increased incidence of chronic lung disease. Clearly the hoped-for cost saving following the introduction of surfactant therapy has not occurred.