Follow-up of infants 501 to 1,500 gm birth weight delivered to residents of a geographically defined region with perinatal intensive care facilities (original) (raw)
Related papers
Medical Care, 2010
To determine the adjusted effect of hospital level of care and volume on mortality of very low birth weight (VLBW) infants in the state of California, where deregionalization of perinatal care has occurred. Research Design: Secondary data analysis of California maternalinfant hospital discharge data from 1997 to 2002 was performed. Logistic regression was used to evaluate the odds of mortality among VLBW infants by hospital level of neonatal intensive care and volume of VLBW deliveries, in the context of differences in antenatal and delivery factors by hospital site of delivery. Results: Both maternal and fetal antenatal risk profiles and delivery characteristics vary by hospital site of delivery. After risk adjustment, lower-level, lower-volume units were associated with a higher odds of mortality. The highest odds of mortality occurred in level-1 units with Յ10 VLBW deliveries per year (odds ratio, 1.69; 95% confidence interval, 1.43-1.99). In isolation, hospital volume, rather than level of care, had the greater effect. Conclusions: Although deregionalization of perinatal services may increase access to care for high-risk mothers and newborns, its impact on hospital volume may outweigh its potential benefit.
A comparison of Wisconsin neonatal intensive care units with national data on outcomes and practices
WMJ : official publication of the State Medical Society of Wisconsin, 2008
Improvements in neonatal care over the past 3 decades have increased survival of infants at lower birthweights and gestational ages. However, outcomes and practices vary considerably between hospitals. To describe maternal and infant characteristics, neonatal intensive care units (NICU) practices, morbidity, and mortality in Wisconsin NICUs, and to compare outcomes in Wisconsin to the National Institute of Child Health and Human Development network of large academic medical center NICUs. The Newborn Lung Project Statewide Cohort is a prospective observational study of all very low birthweight (< or =1500 grams) infants admitted during 2003 and 2004 to the 16 level III NICUs in Wisconsin. Anonymous data were collected for all admitted infants (N=1463). Major neonatal morbidities, including bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) were evaluated. The overall incidence of BPD was 24% (8...
Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2006
Background: Newborns of 30-34 weeks gestation comprise 3.9% of all live births in the United States and 32% of all premature infants. They have been studied much less than very low birthweight infants. Objective: To measure in-hospital outcomes and readmission within three months of discharge of moderately premature infants. Design: Prospective cohort study including retrospective chart review and telephone interviews after discharge. Setting: Ten birth hospitals in California and Massachusetts. Patients: Surviving moderately premature infants born between October 2001 and February 2003. Main outcome measures: (a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in-hospital outcomes-for example, necrotising enterocolitis; (c) readmission within three months of discharge. Results: With the use of prospective cluster sampling, 850 eligible infants and their families were identified, randomly selected, and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay, these babies experienced substantial morbidity: 45.7% experienced assisted ventilation, and 3.2% still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2% of the cohort and was higher among male infants and those with chronic lung disease. Conclusions: Moderately premature infants experience significant morbidity, as evidenced by high rates of assisted ventilation, use of oxygen at 36 weeks, and readmission. Such morbidity deserves more research.
American Journal of Diseases of Children, 1989
Developments in neonatal intensive care over the past 25 years have led to dramatic decreases in infant mortality, to treatments for physical and mental conditions, and to improvement in the quality of life for the infants who survive. Currently, about six percent of infants who are born alive enter neonatal intensive care units; financial and human costs can be substantial, but net financial as well as human benefits generally result.
Mortality rates and neonatal intensive care for very small babies
Archives of Disease in Childhood, 1982
Mortality rates of very small babies (those weighing 1500 g or less) born to mothers normally resident in the 11 health districts of the London portion of the Northeast Thames Health Region in 1971-73 and 1975-77 were compared with admission rates to neonatal intensive care units in 1972 and 1976 in the region. There was no significant correlation between mortality and admission rates for babies weighing 1000 g or less during either period. For babies born weighing between 1001 and 1500 g this was also so in 1972. In 1976 however, mortality rates were significantly correlated negatively at 24 hours but not at 28 days with admission rates to neonatal intensive care. There has been much discussion about the importance of neonatal intensive care'-8 on the survival of very low birthweight babies. Reynolds9 10 has 99-123.
Rehospitalization of extremely-low-birth-weight infants in first 2 years of life
Early Human Development, 2002
Aims: To determine whether (1) chronic lung disease (CLD) is the prime reason for extremelylow-birth-weight (ELBW) infant readmission during the first 2 years of life, (2) surfactant and other advanced therapies have reduced ELBW infant readmissions, (3) home oxygen therapy (HOT) is efficacious for this group. Study design: The hospital records of these ELBW infants were reviewed retrospectively. Data on age, diagnosis, treatment, and duration of each hospitalization were compiled and analyzed for their association to CLD and to readmission for CLD and other reasons. Subjects: All 60 surviving infants with a birth body weight of less than 1001 g (ELBW) born from January 1993 to February 1998 were followed up to 2 years (mean 20.4±7.4 months) to evaluate their respiratory outcome. Results: Forty-two percent of these infants developed CLD. Upon discharge from the hospital, 28% (7/25) of the patients were given HOT for a median period of 60 days. Of the 47 ELBW infants who were studied the entire 2-year period, 72% were readmitted. Infants with CLD were readmitted more frequently ( p=0.045) and had longer hospital stays during the first 2 years of life ( p=0.034) than those without CLD. Respiratory illness was the main reason for readmission (55%) of these ELBW infants. The incidence of readmission due to respiratory tract infection was not significantly different in infants with CLD (61%) and infants without respiratory complications (44%) ( p=0.159). Conclusions: Infants with CLD (whether receiving HOT or not) showed no higher readmission rate due to respiratory infection, but the HOT group did have higher morbidity. The premature lung itself rather than the presence of CLD, as we would expect, makes 0378-3782/02/$ -see front matter D
Outcome of very low birthweight infants who required prolonged hospitalization
Journal of Paediatrics and Child Health, 1984
Over a 4 year study period, 294 infants with a birthweight ~1 5 0 0 g survived their initial hospitalization; 103(35%) were discharged after a gestational age of 40 weeks. The postdischarge infant mortality was significantly higher in those with prolonged initial hospitalization compared with the remaining survivors (6% vs 1 "/o). During the first 2 years, significant infections were found in 66% and rehospitalization in 54% of the children who had prolonged initial hospitalization. At 2 years, 34% were below the 10th centile for weight as were 39% for height; head circumferences were normal. Major disability (27% vs 15%) and developmental delay (13% vs 4%) were significantly more common in survivors with prolonged initial hospitalization compared with the remaining survivors. The study demonstrated the continuing toll of perinatal morbidity among very low birthweight infants who required prolonged hospitalization and emphasized the need for comprehensive medical and social support, not only during their initial hospitalization, but also after discharge.
Rehospitalization Rates of Infants of Less Than 32 Weeks Gestation in the First Year of Life
Marmara Medical Journal, 2005
Objective: Preterm infants are at increased risk of rehospitalization after nursery discharge. We aimed to investigate the perinatal and environmental risk factors associated with increased risk of rehospitalization and determine the causes and duration of the rehospitalizations. Methods: Hospital records of infants of gestational age of less than 32 weeks (n=73) discharged from the neonatal intensive care unit at Marmara University Hospital between the period of 1998-2002 and 100 full-term infants born in the same hospital were reviewed retrospectively. Results: Thirty-two (53%) preterm infants were rehospitalized during-follow up period and 12 (20%) infants were readmitted more than once, whereas 5% of full-term infants were rehospitalized in the first year of life (p>0.5) and perinatal problems such as respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage (p>0.5). Extremely low birth weight infants (ELBW) had a higher risk of rehospitalization (85.7% versus 14.3%), (p=0.02). In full-term infants, hyperbilirubinemia, in preterm infants prematurity anemia , respiratory illness, urinary tract infections were the most common reasons for rehospitalization. Conclusion: In conclusion, preterm infants continue to be confronted by new problems after discharge from hospital and the incidence of rehospitalization is high.
A Selected Review of the Mortality Rates of Neonatal Intensive Care Units
Frontiers in Public Health, 2015
Newborn babies in need of critical medical attention are normally admitted to the neonatal intensive care unit (NICU). These infants tend to be preterm, have low birth weight, and/or have serious medical conditions. Neonatal survival varies, but progress in perinatal and neonatal care has notably diminished mortality rates. In this selected review, we examine and compare the NICU mortality rates and etiologies of death in different countries. Methods: A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, and EMBASE. The primary endpoint was the mortality rates in NICUs. Secondary endpoints included the reasons for death and the correlation between infant age and mortality outcome. For the main analysis, we examined all infants admitted to NICUs. Subgroup analyses included extremely low birth weight infants (based on the authors' own definition), very low birth weight infants, very preterm infants, preterm infants, preterm infants with a birth weight of ≤1,500 g, and by developed and developing countries. results: The literature search yielded 1,865 articles, of which 20 were included. The total mortality rates greatly varied among countries. Infants in developed and developing countries had similar ages at death, ranging from 4 to 20 days and 1 to 28.9 days, respectively. The mortality rates ranged from 4 to 46% in developed countries and 0.2 to 64.4% in developing countries. conclusion: The mortality rates of NICUs vary between nations but remain high in both developing and developed countries.