Original ArticleTrends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries
Section snippets
Methods
In our retrospective cohort study, neonates born between January 1, 2007, and December 31, 2015, weighing <1500 g at 240/7 to 316/7 weeks of gestational age, and admitted to a neonatal intensive care unit (NICU) participating in a national neonatal network/registry included in iNeo were eligible. Neonates who were born at <24 weeks of gestational age, ≥32 weeks of gestational age, or had major congenital anomalies were excluded. Neonates <24 weeks of gestational age were excluded because
Results
Of the total 200 472 neonates in the dataset, 154 233 were eligible for this study. A total of 46 239 neonates were excluded from the analysis: 6970 were <24 weeks of gestational age, 33 379 were ≥32 weeks of gestational age, and 5890 had major congenital anomalies. The rates of multiple births and outborn neonates were significantly lower in epoch 2 (2012 and 2015) than epoch 1 (2007-2011), and rates of cesarean delivery, antenatal steroid use, and Apgar score of <7 at 5 minutes were
Discussion
In this large international cohort from 11 countries, we identified that mortality and major morbidities decreased between 2007 and 2015 in most countries. However, there was an increase in BPD in most countries except Canada. Subtle differences in population characteristics were identified that may or may not explain these differences.
The strengths of our study are a high-risk, large, international, multiple country cohort; a standardized reporting system within each country; and a focus on
Data Statement
Data sharing statement available at www.jpeds.com.
References (42)
- et al.
Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis
Lancet
(2015) - et al.
Neonatal outcomes of very low birth weight and very preterm neonates: an international comparison
J Pediatr
(2016) - et al.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm
J Pediatr
(1978) - et al.
Neurodevelopmental outcomes of infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units based on location of birth
J Pediatr
(2018) - et al.
Prevention and management of bronchopulmonary dysplasia: lessons learned from the neonatal research network
Semin Perinatol
(2016) - et al.
Quality improvement initiatives in neonatal intensive care unit networks: achievements and challenges
Acad Pediatr
(2013) - et al.
Causes and timing of death in extremely premature infants from 2000 through 2011
N Engl J Med
(2015) - et al.
Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012
JAMA
(2015) - et al.
The economic burden of prematurity in Canada
BMC Pediatr
(2014) - et al.
Risk factors and estimation tool for death among extremely premature infants: a national study
Pediatrics
(2010)
Australian New Zealand Neonatal Network. Outcomes for high risk New Zealand newborn infants in 1998-1999: a population based, national study
Arch Dis Child Fetal Neonatal Ed
Neonatal Data Analysis Unit and the Medicines for Neonates Investigator Group. Impact of managed clinical networks on NHS specialist neonatal services in England: population based study
BMJ
One-year survival of extremely preterm infants after active perinatal care in Sweden
JAMA
Morbidity and mortality of infants with very low birth weight in Japan: center variation
Pediatrics
Variations in practice and outcomes in the Canadian NICU network: 1996-1997
Pediatrics
The International Network for Evaluating Outcomes of very low birth weight, very preterm neonates (iNeo): a protocol for collaborative comparisons of international health services for quality improvement in neonatal care
BMC Pediatr
Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network
Arch Dis Child Fetal Neonatal Ed
Outcome comparison of very preterm infants cared for in the neonatal intensive care units in Australia and New Zealand and in Canada
J Paediatr Child Health
Association of a quality improvement program with neonatal outcomes in extremely preterm infants: a prospective cohort study
CMAJ
Sustained quality improvement in outcomes of preterm neonates with a gestational age less than 29 weeks: results from the Evidence-based Practice for Improving Quality Phase 3
Can J Physiol Pharmacol
Respiratory management of extremely preterm infants: an international survey
Neonatology
Cited by (153)
Extreme prematurity: Factors associated with perinatal management and morbi-mortality in western Normandy, France
2024, Journal of Gynecology Obstetrics and Human ReproductionDeveloping a length of stay prediction model for newborns, achieving better accuracy with greater usability
2023, International Journal of Medical InformaticsThe role of oxygen in the development and treatment of bronchopulmonary dysplasia
2023, Seminars in Perinatology
Funding and disclosure information is available at www.jpeds.com.
Portions of this study were presented at the Pediatric Academic Society Meeting, May 5-8, 2018, Toronto, Ontario, Canada; and the congress of Joint European Neonatal Societies (jENS), October 31 – November 4, 2017, Venice, Italy.
- ∗
List of iNeo investigators can be found in the Appendix (www.jpeds.com).