Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s.

Autor:	Cheong JLY; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia jeanie.cheong@thewomens.org.au.; Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.; Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia., Olsen JE; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.; Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia., Huang L; Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia., Dalziel KM; Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia., Boland RA; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Nursing, University of Melbourne, Parkville, Victoria, Australia.; Paediatric Infant Perinatal Emergency Retrieval, , Royal Children's Hospital, Parkville, Victoria, Australia.; Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia., Burnett AC; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.; Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.; Paediatrics, University of Melbourne, Parkville, Victoria, Australia., Haikerwal A; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia., Spittle AJ; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Physiotherapy, University of Melbourne, Parkville, Victoria, Australia., Opie G; Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.; Mercy Hospital for Women, Heidelberg, Victoria, Australia., Stewart AE; Newborn Services, Monash Medical Centre Clayton, Clayton, Victoria, Australia., Hickey LM; Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.; Paediatrics, University of Melbourne, Parkville, Victoria, Australia., Anderson PJ; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Monash University Monash Institute of Cognitive and Clinical Neuroscience, Clayton, Victoria, Australia., Doyle LW; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.; Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.; Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2020 Sep 10; Vol. 10 (9), pp. e037507. Date of Electronic Publication: 2020 Sep 10.
DOI:	10.1136/bmjopen-2020-037507
Abstrakt:	Objectives: It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22-27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s. Design: Prospective longitudinal cohort study. Setting: The State of Victoria, Australia. Participants: All EP births offered intensive care in four discrete eras (1991-1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016-March 2017 (12 months): n=250). Outcome Measures: Consumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated. Results: Median duration of any respiratory support increased from 22 days (1991-1992) to 66 days (2016-2017). The increase occurred in non-invasive respiratory support (2 days (1991-1992) to 51 days (2016-2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016-2017. Survival to discharge home increased (68% (1991-1992) to 87% (2016-2017)). Cystic periventricular leukomalacia decreased (6.3% (1991-1992) to 1.2% (2016-2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991-1992) to 10.0% (2016-2017)). The average additional costs associated with one additional infant surviving in 2016-2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991-1992, 1997 and 2005, respectively. Conclusions: Consumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu