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Changing trend in perinatal management and outcome of extremely low birthweight (ELBW) infants
N W Svenningsen1, L Björklund, M Lindroth
1NICU, Department of Paediatrics, University Hospital, Lund, Sweden.
Insights
Improving respiratory care for extremely low birthweight (ELBW) infants led to better survival rates and fewer complications. Refined medical and nursing practices significantly enhance outcomes for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Perinatal care for extremely preterm and low birthweight (ELBW) infants relies on physiological principles and understanding pathophysiological mechanisms.
- Introduction of new therapies in clinical practice is often gradual, involving a learning process rather than abrupt changes.
Purpose of the Study:
- To evaluate the impact of evolving respiratory care strategies on outcomes for ELBW infants over a 9-year period.
- To analyze trends in survival rates and the incidence of major morbidities in ELBW infants.
Main Methods:
- Retrospective analysis of respiratory care for 325 ELBW infants born between 1986 and 1994.
- Trend analysis of survival rates and the occurrence of bronchopulmonary dysplasia and/or major intracranial hemorrhages (ICH grades 3 and 4).
Main Results:
- Infant characteristics (birthweight and gestational age) remained consistent over the study period.
- Survival rates increased significantly from 47% to 70% (p < 0.04).
- The percentage of survivors without bronchopulmonary dysplasia and/or major ICH (grades 3 and 4) improved from 67% to 87% (p < 0.006).
Conclusions:
- Refinement and optimization of nursing and medical care procedures, in addition to medical treatments, positively impact the overall outcomes for ELBW infants.
- Continuous quality improvement in perinatal care is crucial for enhancing survival and reducing morbidities in extremely preterm infants.
Abstract:
Perinatal care of the extremely preterm and low birthweight (ELBW) infant is founded on basic principles of physiology and knowledge about the prevailing pathophysiological mechanisms. New therapies in clinical care are usually introduced non-uniformly, so more often there is a gradual rather than a sudden change in the development of perinatal care, conceivably involving also an important learning process. This was confirmed in an evaluation of respiratory care for ELBW infants (n = 325) over a 9-year period (1986-1994). Although birthweight (mean 815 g) and degree of immaturity at birth (mean 26.7 weeks of gestation) did not change over the years, our trend analysis showed that the survival rate increased from 47% to 70% (p < 0.04) and the percentage of survivors without bronchopulmonary dysplasia and/or major intracranial haemorrhages (ICH grades 3 and 4) increased from 67% to 87% (p < 0.006). We suggest that besides medical treatment per se, refinement and tuning of nursing and medical care procedures will also affect the total outcome of ELBW infants.