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Disproportionate consumption of ventilator resources by very preterm survivors persists in the 1990s
1Division of Paediatrics, the Royal Women's Hospital, Carlton, Victoria, Australia.
Insights
Preterm infants born earlier required significantly more days of assisted ventilation over three decades. Despite advances in perinatal care, the duration of respiratory support for survivors did not decrease.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Preterm infants require significant nursery resources, particularly for respiratory support.
- Changes in perinatal care and technology may influence resource utilization.
- Understanding trends in resource consumption is crucial for healthcare planning.
Purpose of the Study:
- To analyze changes in nursery resource consumption by surviving preterm infants over time.
- To examine the relationship between gestational age and the duration of assisted ventilation.
- To assess the impact of different eras of perinatal care on resource utilization.
Main Methods:
- Retrospective analysis of consecutive livebirths between 23 and 30 weeks gestational age.
- Data collected across three distinct eras: 1977-1985, 1986-1990, and 1991-1995.
- Focus on survival rates and days of assisted ventilation for preterm infants.
Main Results:
- Survival rates increased with gestational age and across successive eras.
- Overall consumption of assisted ventilation resources by survivors increased over time.
- Infants born before 28 weeks consistently required substantially more days of ventilation than those born between 28-30 weeks, with little change in this trend over time.
Conclusions:
- Gestational age remains a primary determinant of assisted ventilation duration in preterm infants.
- Improvements in perinatal care did not shorten the duration of respiratory support for survivors.
- Resource utilization for assisted ventilation in preterm infants has increased over recent decades.
Abstract:
The aim of this study of consecutive livebirths between 23 and 30 weeks of gestational age was to determine the changes over time in the relationship between gestational age and the consumption of nursery resources by surviving preterm infants. Three discrete eras, comprising the years 1977-1985, 1986-1990, and 1991-1995, were identified, based on availability of ventilators and changes in perinatal care. The survival rate rose dramatically with each week's increase in gestational age, and increased significantly between successive eras. Overall, consumption of resources for assisted ventilation by survivors increased over time. In infants born before 28 weeks, for each week of decrease in gestational age, survivors averaged an extra 12.9 days of assisted ventilation in 1977-1985, 13.4 days in 1986-1990, and 13.5 days in 1991-1995, while infants born between 28-30 weeks of gestational age needed only an extra 2.3 days, 3.3 days, and 4.6 days of assisted ventilation for each week of decrease in gestational age in successive eras, respectively. There was no indication that improvements in perinatal care over time shortened the duration of assisted ventilation for surviving preterm infants.