Survival and causes of death in extremely preterm infants in the Netherlands.
Arch Dis Child Fetal Neonatal Ed
; 106(3): 251-257, 2021 05.
Article
in En
| MEDLINE
| ID: mdl-33158971
ABSTRACT
OBJECTIVE:
In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.DESIGN:
National cohort study, using data from the Netherlands Perinatal Registry. PATIENTS The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group. MAIN OUTCOMEMEASURES:
Survival to discharge, as well as cause and timing of death.RESULTS:
After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006).CONCLUSIONS:
Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.Key words
Full text:
1
Collection:
01-internacional
Health context:
2_ODS3
/
4_TD
/
6_ODS3_enfermedades_notrasmisibles
/
7_ODS3_muertes_prevenibles_nacidos_ninos
Database:
MEDLINE
Main subject:
Respiratory Distress Syndrome, Newborn
/
Cause of Death
/
Enterocolitis, Necrotizing
/
Stillbirth
/
Infant, Extremely Premature
/
Neonatal Sepsis
Type of study:
Etiology_studies
/
Guideline
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Infant
/
Male
/
Newborn
Country/Region as subject:
Europa
Language:
En
Journal:
Arch Dis Child Fetal Neonatal Ed
Year:
2021
Document type:
Article