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Frequency of neurologic disorders in the neonatal intensive care unit
1Department of Neurology, University of Wisconsin Medical School, Madison 53792-5132, USA.
Insights
Neonatal intensive care unit survival improved, but concerns about infant neurologic disorders persisted. However, this study found a significant decline in neurologic disorders among neonatal intensive care unit survivors.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Public Health
Background:
- Neonatal intensive care unit (NICU) survival rates have risen, particularly for preterm infants.
- Neurologic morbidity is a significant predictor of long-term disability in survivors.
- Concerns exist regarding an increasing burden of neurologic dysfunction among NICU survivors.
Purpose of the Study:
- To analyze trends in neurologic disorders among NICU admissions.
- To assess changes in neurologic morbidity in relation to survival rates.
Main Methods:
- Retrospective analysis of 4164 NICU admissions from 1986-1995.
- Examination of neurologic disorder incidence, mortality rates, and specific conditions.
- Comparison of data between the early and late periods of the study.
Main Results:
- NICU mortality decreased from 12% to 4.2% between 1986 and 1995.
- The incidence of neurologic disorders dropped by over 50%, from 27% to 12%.
- Specific conditions like seizures, hypoxic-ischemic encephalopathy, and intraventricular hemorrhage significantly decreased.
Conclusions:
- Improved NICU care has led to a substantial reduction in perinatally acquired neurologic disorders.
- Despite increased survival, neurologic dysfunction in NICU survivors has declined.
- These findings challenge concerns about rising neurologic morbidity in NICU populations.
Abstract:
Neonatal intensive care unit survival rates have improved significantly over the past decade. This improvement primarily reflects declining mortality rates among preterm infants. Neurologic morbidity increases with prematurity and is the major predictor of long-term disability. Accordingly, concern has been expressed that the burden of neurologic dysfunction among contemporary neonatal intensive care unit survivors may be increasing. To define the trends of neurologic disorders in the contemporary neonatal intensive care unit, all 4164 admissions between 1986 and 1995 to a tertiary neonatal intensive care unit were examined. Neonatal intensive care unit admissions (413 +/- 49 per year), proportion of births at less than 37 weeks (70 +/- 3% per year), and referral patterns were stable between 1986 and 1995. Over the study period, 773 (18%) of 4164 neonatal intensive care unit infants had a total of 1062 neurologic disorders. The neonatal intensive care unit mortality rate declined from 12% in 1986 to 4.2% in 1995 (P < .01). Neurologic disorders declined, from 27% of infants born in 1986 to 12% in 1995 (P < .001): 356 had seizures (14% in 1986 to 4% in 1995; P < .001), 235 had hypoxic-ischemic encephalopathy (8% in 1986 to 4% in 1995, P < .01), and 167 had intraventricular hemorrhage (7% in 1986 to 1.4% in 1995, P < .005). Frequency of congenital or chromosomal aberration affecting the nervous system was relatively constant (4.5% per year). Despite a three-fold improvement in neonatal intensive care unit survival between 1986 and 1995, the frequency of perinatally acquired neurologic disorders declined by more than 50%.