Trends in Mortality and Morbidity in Infants Under 500 Grams Birthweight: Observations from Our Neonatal Intensive Care Unit (NICU) (original) (raw)
Related papers
The Indian Journal of Pediatrics, 2012
Objective To determine the morbidity and mortality in ELBW babies till discharge from a Neonatal Intensive Care Unit (NICU). Methods This study was a prospective observational study conducted in a 40 bed well equipped level III care NICU between 01.12.2006 and 30.04.2008. All ELBW babies admitted during this period were assessed for morbidities and interventions required during NICU stay and for their outcome like survival or death. Results The survival rate of 87 ELBW babies admitted during this period was 56.1 %. Pulmonary hemorrhage was the commonest cause of death (25 %) followed by respiratory distress syndrome (22.5 %), intraventricular hemorrhage (22.5 %) and sepsis (20 %). Significantly higher number of non-survivors were <750 g at birth (p00.0001) and <28 wk gestation (p00.0001). Small for gestational babies had better chances of survival compared to those appropriate for gestational age (p00.005). RDS (67.8 %), probable sepsis (62.1 %) and hyperbilirubinemia (59.8 %) were the most frequent morbidities. Conventional ventilation (72.4 %) and nasal CPAP (48.3 %) were the commonest respiratory interventions. Surfactant replacement therapy was required in 47.1 % babies. Conclusions ELBW babies have a major contribution to mortality in a NICU. Babies with birth weight <750 g and gestation <28 wk have poor survival. RDS, pulmonary hemorrhage, IVH and sepsis are the common causes of death while RDS, sepsis and hyperbilirubinemia are the most common morbidities.
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.
Morbidity in early term and full-term neonates in a NICU
Journal of Pediatric and Neonatal Individualized Medicine, 2018
INTRODUCTION Term neonates (37-41 weeks' gestation) have been considered as a homogeneous group – regarding morbidity – when compared to preterm and post term neonates. But there is substantial evidence suggesting that significant differences exist in the outcomes of infants delivered within this 5-week interval. As morbidity appears to be greater for neonates born at 37-38+6/7 weeks of gestation than for those born at 39-41 weeks, the adoption of the ACOG-recommended designations – “early term” for neonates born at 37 to 38 completed weeks' gestation and “full term” for those born at 39 to 40 weeks' gestation – is considered necessary. AIM To assess morbidity in early term neonates (ET) compared to full term neonates (FT). METHODS A retrospective study was conducted, with data from our NICU's electronic archives, concerning 124 term neonates hospitalized in the NICU during 2016. The study population was divided into two groups: ET and FT neonates. The type of delivery, body temperature on admission, the incidence of RDS, asphyxia/stress, septicemia, mechanical ventilation/oxygen therapy, the day of full enteral feeding and the duration of hospitalization were recorded. RESULTS Statistically significant differences were noticed, regarding the type of delivery, with ET neonates (n = 68) being born mainly via caesarean section (CS) (77.9%), and among them 71.2{\%} via elective CS. In ET neonates, an increased incidence of RDS, prolongation of mechanical ventilationoxygen therapy-hospitalization stay, and delay of full enteral feeding (p value < 0.05) were observed. On the other hand, FT neonates (56) showed an increased incidence of asphyxia/stress (p value = 0.016) and septicemia (p value = 0.27). CONCLUSIONS According to our study results, there was an increased morbidity of ET neonates, a finding consistent with literature data. We believe that our findings confirm furthermore the need to reconsider the optimal timing for delivery in uncomplicated pregnancies.
IOSR Journals , 2019
Background In recent trends, there is increasing number of babies born with very low birth weight. These VLBW babies are at risk of developing hypoglycemia, sepsis, hyperbilirubinemia, respiratory distress when compared to term babies. By studying the risk factors leading to very low birth weight and their morbidities, health professionals will be able to anticipate and manage them accordingly. Methods This is a Prospective cohort study where all VLBW neonates admitted in our NICU were enrolled. Relevant details were collected which includes maternal details, maternal risk factors, order of birth, gestational age , antenatal steroids, mode of delivery and baby's details include their sex, need of resuscitation, Apgar score, gestational age, birth weight and need of mechanical ventilation , surfactant therapy were recorded Results: A total of 382 VLBW neonates were included. Out of 382 neonates, 199(52%) were males and 183(48%) were females, 195(51%) were born out of normal vaginal delivery and 187(49%) by caesarean section. Their Mean birth weight was 1.25 kg in males and 1.27 kg in females. Majority of VLBW neonates were in the gestational age group between 28-32 weeks (n = 224, 59%) and 32-34 weeks (n = 92, 24%).The most common maternal risk factor associated with VLBW being Gestational hypertension-210(55%) followed by Anemia-63(17%),.The major morbidity was sepsis (n=133, 35%) followed by RDS (n= 105, 27%), TTN (n= 85, 22%). The most common mortality was Sepsis (n=49, 52%), RDS (n= 38, 40%). Conclusion Prematurity is the primary cause behind these neonatal deaths. This emphasizes the need to prevent preterm deliveries. Effective preventive strategies to decrease the preterm birth will be the next big step to decrease the perinatal morbidity rate.
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.
Pulmonology, 2018
Introduction: Although non-invasive forms of ventilation have recently spread in neonatology, invasive ventilation still plays a key role in the support of extremely low birth weight (ELBW) infants. The purpose of this study was to assess changes in neonatal ventilation practices for ELBW infants and compare outcomes between two epochs (2005-2009 vs. 2010-2015) to analyze progression stemming from the implementation of newer clinical guidelines. Materials and methods: We conducted a retrospective study with data collection from all ELBW infants born between 2005 and 2015 in our center through their individual clinical records. The main outcome was the prevalence of bronchopulmonary dysplasia (BPD) in both periods. Assessment of other morbidities and survival were secondary outcomes. Results: A hundred and thirty-one infants were included; median gestational age of 27 weeks (23-33) and mean birth weight of 794.58 g (±149.37). Invasive mechanical ventilation (IMV) was performed on 103 (78.6%) infants. Non-significant increases in the use of non-invasive mechanical ventilation (NIMV) were observed between epochs both exclusively and following IMV. In conventional ventilation there were significant variations between epochs, namely a decrease in synchronized intermittent mandatory ventilation (SIMV) and a major growth in the addition of volume guarantee (VG). Significant decreases in BPD (from 50.9% to 32.0%) and cystic periventricular leukomalacia (cPVL) (from 27.5% to 10.7%) were observed between epochs, with no major changes in other morbidities and survival. Conclusion: Changes in our neonatal intensive care unit's ventilatory practices according to the most up-to-date guidelines, have led to a decrease in BPD and cPVL, over an 11-year period.
2020
Summary: Considerable progress has been made regarding children’s morbidity and mortality. Nonetheless, recent developments have been insufficient to meet set targets. This study aims to evaluate trends and outcomes in respiratory management following a 14-year collaboration with the Vermont Oxford Network (VON).Methods: Data were collected prospectively at a Level III NICU in the North of Portugal and submitted to the VON between 2000 and 2013. The primary outcome was bronchopulmonary dysplasia (BPD). Pneumothorax and respiratory distress syndrome were secondary outcomes. Results: A total of 323 very low birth weight infants hospitalised in our centre met the inclusion criteria. Significant changes were observed with supplemental oxygen use and endotracheal intubation decreasing, whilst surfactant use rose. Conventional ventilation techniques at any time were used less often. No differences in the rates of BPD were observed.Conclusion: A review of current practice has led to a more...
Comparison of mortality risk: a score for very low birthweight infants Commentary
Archives of Disease in Childhood-fetal and Neonatal Edition, 1997
Aim-To develop and evaluate a score which quantifies mortality risk in very low birthweight (VLBW) infants (birthweight below 1500 g) at admission to the neonatal intensive care unit. Methods-Five hundred and seventy two VLBW infants admitted from 1978 to 1987 were randomly assigned to a cohort (n = 396) for score development and a cohort (n = 176) for score validation. Two hundred and ninety four VLBW infants admitted from 1988 to 1991 were used to compare risk adjusted mortality between the two eras. Results-Using multiple regression analysis, birthweight, Apgar score at 5 minutes, base excess at admission, severity of respiratory distress syndrome, and artificial ventilation were predictive of death in the development cohort. According to regression coeYcients, a score ranging from 3 to 40 was developed. At a cutoV of 21, it predicted death in the validation cohort with a sensitivity of 0.85, a specificity of 0.73, and a correct classification rate of 0.76. The area under the receiver operating characteristic curve was 0.86. There was no significant diVerence in risk severity and in risk adjusted mortality between the eras 1978-87 and 1988-91. Conclusion-The present score is robust, easily obtainable at admission, and permits early randomisation based on mortality risk.