The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain

Autor: María Dolores Elorza Fernández, Máximo Vento Torres, Josep Figueras Aloy, Fermín García-Muñoz Rodrigo, Antonio Losada Martínez, Julio Moreno Hernando
Rok vydání: 2016
Předmět:
Male
congenital
hereditary
and neonatal diseases and abnormalities
Pediatrics
medicine.medical_specialty
Respiratory Therapy
Time Factors
Databases
Factual
Perinatal care
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
mental disorders
Infant Mortality
medicine
Birth Weight
Humans
Infant
Very Low Birth Weight
030212 general & internal medicine
Practice Patterns
Physicians'
reproductive and urinary physiology
Retrospective Studies
Noninvasive Ventilation
Continuous Positive Airway Pressure
business.industry
Respiratory disease
Infant
Newborn
Oxygen Inhalation Therapy
Infant
Pulmonary Surfactants
medicine.disease
Respiration Disorders
Low birth weight
Perinatal Care
Treatment Outcome
Bronchopulmonary dysplasia
Spain
Pediatrics
Perinatology and Child Health
Practice Guidelines as Topic
Female
Steroids
Guideline Adherence
medicine.symptom
business
Developmental Biology
Zdroj: Neonatology. 112(1)
ISSN: 1661-7819
Popis: Background: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. Objectives: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). Methods: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants 0 or >346 weeks of gestational age (GA) were excluded. Results: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of “outborn” patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001). Conclusions: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.
Databáze: OpenAIRE
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