Predischarge Morbidities in Extremely and Very Low-Birth-Weight Infants in Spanish Neonatal Units

ABSTRACT

We sought to describe neonatal morbidities and therapeutic interventions in very low-birth-weight (VLBW) and extremely low-birth-weight (ELBW) infants cared for in Spanish hospitals. We preformed a prospective collection of data covering the perinatal period until discharge by the SEN1500 network. This network, set up by the Spanish Society of Neonatology, targets VLBW and ELBW infants (400 to 1500 g) admitted to neonatal units in Spanish hospitals. Data were recorded in electronic form and controlled for possible errors or inconsistencies before analysis. We report data for 8836 neonates admitted to 48 neonatal units from January 2002 to December 2005. Prenatal steroids were given to significantly more newborns in 2003 to 2005 (79.4%) than in 2002 (73.4%), although the remaining perinatal data examined failed to significantly vary. Delivery was by cesarean section in 69.8% of cases but significantly lower (35.9%) for infants under a postmenstrual age of 26 weeks. Hyaline membrane disease was diagnosed in 53.9% of the newborns and bronchopulmonary dysplasia (BPD) in 10.46%. Mechanical ventilation was employed in 69.1%, surfactant in 50.3%, and steroids for BPD in 5.3%. Intraventricular hemorrhage grades 3 to 4 (8.1%) and cystic leukomalacia (2.6%) were the most relevant brain ultrasonography findings. Rates of early- and late-onset septicemia were 5% and 29.4%, respectively. Further diagnoses were necrotizing enterocolitis (NEC; 6.9%) and persistent ductus arteriosus (PDA; 24.2%); 40.6% of the cases of NEC and 15.3% of those of PDA required surgery. In addition, 26.6% of the newborns required supplementary oxygen at 28 days of life. The number of newborns who had not recovered their birth weight at this age fell from 3.1% in 2002 to 1.5% in 2005. Rates of prenatal steroid use, cesarean delivery, and main morbidities were comparable to figures cited for other patient series, although our BPD rate was among the lowest reported and nosocomial sepsis rate among the highest.

Very low-birth-weight infant - preterm morbidity - clinical status at 28 days and on discharge - neonatal network

REFERENCES

• 1 Thakkar M, O'Shea M. The role of neonatal networks.  Semin Fetal Neonatal Med. 2006;  11 105-110
• 2 Vermont Oxford Network .http://htpp://www.vtoxford.org 2007
• 3 Horbar J D. The Vermont Oxford network: evidence based quality improvement for neonatology.  Pediatrics. 1999;  103 350-359
• 4 Horbar J D, Rogowski J, Pisek P E et al.. Collaborative quality improvement for neonatal intensive care. NIC/Q project investigators of the Vermont Oxford Network.  Pediatrics. 2001;  107 14-22
• 5 Lee S K, McMillan D D, Ohlsson A et al.. Sale J and the Canadian NICU network. Variations in practice and outcomes in the Canadian NICU network: 1996–1997.  Pediatrics. 2000;  106 1070-1079
• 6 Darlow B A, Cust A E, Donoghue D A. Improved outcomes for very low birthweight infants: evidence from New Zealand national population based data.  Arch Dis Child Fetal Neonatal Ed. 2003;  88 F23-F28
• 7 Shinwell E S, Blickstein I, Reichman B. in collaboration with the Israel Neonatal Network . Excess risk of mortality in very low birthweight triplets: a national population based study.  Arch Dis Child Fetal Neonatal Ed. 2003;  88 F36-F40
• 8 Figueras-Aloy J, Moro Serrano M, Pérez Rodríguez J, Fernández Pérez C, Roqués Serradilla V, Quero Jiménez J, Jiménez González R. and the SEN1500 Spanish neonatal network . Antenatal glucocorticoid treatment decreases mortality and chronic lung disease in survivors among 23–to–28 week gestational age preterm infants.  Am J Perinatol. 2005;  22 441-448
• 9 Bartels D B, Kreienbock L, Dammann O, Wenlaff P, Poets C F. Population based study on the outcome of small for gestational age newborns.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F53-F59
• 10 Moro M, Fernández C, Figueras J et al.. SEN1500: diseño y desarrollo del registro de niños de menos de 1.500 g al nacer en España.  An Pediatr (Barc). 2008;  68 181-188
• 11 Moro M, Figueras-Aloy J, Fernández C et al.. Mortality for newborns of birthweight less than 1500 g in Spanish neonatal units (2002–2005).  Am J Perinatol. 2007;  24 593-601
• 12 Stark A R. American Academy of Pediatrics Committee on Fetus and Newborn . Levels of neonatal care.  Pediatrics. 2004;  114 1341-1347
• 13 Jobe A H, Bancalari E. Bronchopulmonary dysplasia.  Am J Respir Crit Care Med. 2001;  163 1723-1729
• 14 Papile L A, Burstein J, Burstein R, Kofler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 gm.  J Pediatr. 1978;  92 529-534
• 15 Bell M J, Ternberg J L, Feigin R D et al.. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.  Ann Surg. 1978;  187 1-7
• 16 The Committee for the Classification of Retinopathy of Prematurity. . An international classification of retinopathy of prematurity.  Arch Ophtalmol. 1984;  102 1130-1134
• 17 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
• 18 Fanaroff A A, Stoll B J, Wright L L, Carlo W A, Ehrenkranz R A, Stark A R et al.. NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants.  Am J Obstet Gynecol. 2007;  196 147.e1-8
• 19 Petrova A, Mehta R, Anwar M, Hiatt M, Hegvi T. Impact of race and ethnicity on the outcome of infants below 32 weeks gestation.  J Perinatol. 2003;  23 404-408
• 20 Hentschel J, Berger T M, Tschopp A, Müller M, Adams M. Population based study of bronchopulmonary dysplasia in very low birth weight infants in Switzerland.  Eur J Pediatr. 2005;  164 292-297
• 21 Berg C J, Zupan J, d'Almada P J, Khoury M J, Fuller L J. Gestational age and intrauterine growth retardation among white and black very low birthweight infants: a population based cohort study.  Paediatr Perinat Epidemiol. 1994;  8 53-61
• 22 Sharma P, McKay K, Rosenkrantz T S, Hussain N. Comparisons of mortality and pre-discharge respiratory outcomes in small-for-gestational-age and appropriate-for gestational-age premature infants.  BMC Pediatr. 2004;  4 9
• 23 Walsh M C, Yao Q, Horbar J D, Carpenter J H, Lee S K, Ohlsson A. Changes in the use of postnatal steroids for bronchopulmonary dysplasia in 3 large neonatal networks.  Pediatrics. 2006;  118 el328-el335
• 24 Kaiser J R, Tilford J M, Simpson P M, Salhab W A, Rosenfeld C R. Hospital survival of very-low-birth-weight neonates from 1997 to 2000.  J Perinatol. 2004;  24 343-350
• 25 Finer N N, Horbar J D, Carpenter J H. and the Vermont Oxford Network . Cardiopulmonary resuscitation in the very low birth weight infant: the Vermont Oxford Network experience.  Pediatrics. 1999;  104 428-434
• 26 International Liaison Committee on Resuscitation . 2005 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 7: neonatal resuscitation.  Resuscitation. 2005;  67 293-303
• 27 Burón Martínez E, Aguayo Maldonado J. y grupo de RCP neonatal de la Sociedad Española de Neonatología . Reanimación del recién nacido.  An Pediatr (Barc). 2006;  65 470-477
• 28 Escrig R, Arruza L, Izquierdo I et al.. Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: a prospective, randomized trial.  Pediatrics. 2008;  121 875-881
• 29 St John E B, Carlo W A. Respiratory distress syndrome in VLBW infants: changes in management and outcomes observed in the NICHD neonatal research network.  Semin Perinatol. 2003;  27 288-292
• 30 Ammari A, Suri M, Milisavljevic V et al.. Variables associated with the early failure of nasal CPAP in very low birth weight infants.  J Pediatr. 2005;  147 341-347
• 31 Grupo de trabajo sobre Patología Respiratoria de la Sociedad Española de Neonatología. . High frequency oscillatory ventilation in neonates.  An Esp Pediatr. 2002;  57 238-243
• 32 Barrington K J. Postnatal steroids and neurodevelopmental outcomes: a problem in the making.  Pediatrics. 2001;  107 1425-1426
• 33 Uga N, Ishii T, Kawase Y, Arai H, Tada H. Nitric oxide inhalation therapy in very low-birthweight infants with hypoplastic lung due to oligohydramnios.  Pediatr Int. 2004;  46 10-14
• 34 Hallman M, Aikio O. Nitric oxide in critical respiratory failure of very low birth weight infants.  Paediatr Respir Rev. 2004;  5(Suppl A) S249-S252
• 35 Makhoul I R, Bental Y, Weisbrod M, Sujov P, Lusky A, Reichman B. Israel Neonatal Network. Candidal versus bacterial late-onset sepsis in very low birthweight infants in Israel: a national survey.  J Hosp Infect. 2007;  65 237-243
• 36 Ronnestad A, Abrahamsen T G, Medbo S et al.. Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding.  Pediatrics. 2005;  115 e269-e276
• 37 Benjamin Jr D K, Stoll B J, Fanaroff A A et al.. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months.  Pediatrics. 2006;  117 84-92
• 38 Sankaran K, Puckett B, Lee D S et al.. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units.  J Pediatr Gastroenterol Nutr. 2004;  39 366-372
• 39 Kusuda S, Fujimura M, Sakuma I et al.. Morbidity and mortality of infants with very low birth weight in Japan: center variation.  Pediatrics. 2006;  118 e1130-e1138
• 40 Todd D A, Wright A, Smith J. The NICUS group. Severe retinopathy of prematurity in infants < 30 weeks' gestation in New South Wales and the Australian capital territory from 1992–2002.  Arch Dis Child Fetal Neonatal Ed. 2007;  92 F251-F254
• 41 Gilbert C, Fielder A, Gordillo L et al.. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development. Implications for screening programs.  Pediatrics. 2005;  115 e518-525
• 42 Chow L C, Wright K W, Sola A. CSMC oxygen administration study group. Can changes in clinical practice decrease the incidence of severe retinopathy in very low birth weight infants?.  Pediatrics. 2003;  111 339-345
• 43 Vanderveen D K, Mansfield T A, Eichenwald E C. Lower oxygen saturation alarm limits decrease the severity of retinopathy of prematurity.  J AAPOS. 2006;  10 445-448
• 44 Greenough A, Alexander J, Burgess S et al.. High versus restricted use of home oxygen therapy, health care utilisation and the cost of care in chronic lung disease infants.  Eur J Pediatr. 2004;  163 292-296