Elsevier

The Journal of Pediatrics

Volume 215, December 2019, Pages 32-40.e14
The Journal of Pediatrics

Original Article
Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

https://doi.org/10.1016/j.jpeds.2019.08.020Get rights and content

Objective

To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates.

Study design

In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 240/7 to 316/7 weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed.

Results

For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany.

Conclusions

In most countries, mortality decreased whereas BPD increased for neonates born very preterm.

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.

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    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).

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