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Logo of bmcpediBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Pediatrics
 
BMC Pediatr. 2012; 12: 17.
Published online Feb 22, 2012. doi:  10.1186/1471-2431-12-17
PMCID: PMC3311070
Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years
Christoph Rüegger,corresponding author1,2 Markus Hegglin,1 Mark Adams,1 and Hans Ulrich Bucher1, the Swiss Neonatal Network
1Division of Neonatology, University Hospital Zurich, Zurich, Switzerland
2Division of General Pediatrics, Graubuenden Cantonal Hospital, Chur, Switzerland
corresponding authorCorresponding author.
Christoph Rüegger: ch.rueegger/at/gmail.com; Markus Hegglin: mhegglin/at/yahoo.com; Mark Adams: mark.adams/at/usz.ch; Hans Ulrich Bucher: buh/at/usz.ch
Received November 8, 2011; Accepted February 22, 2012.
Abstract
Background
Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants. Only a few publications analyse changes of their short-term outcome in a geographically defined area over more than 10 years. We therefore aimed to investigate the net change of VP- and VLBW infants leaving the hospital without major complications.
Methods
Our population-based observational cohort study used the Minimal Neonatal Data Set, a database maintained by the Swiss Society of Neonatology including information of all VP- and VLBW infants. Perinatal characteristics, mortality and morbidity rates and the survival free of major complications were analysed and their temporal trends evaluated.
Results
In 1996, 2000, 2004, and 2008, a total number of 3090 infants were enrolled in the Network Database. At the same time the rate of VP- and VLBW neonates increased significantly from 0.87% in 1996 to 1.10% in 2008 (p < 0.001). The overall mortality remained stable by 13%, but the survival free of major complications increased from 66.9% to 71.7% (p < 0.01). The percentage of infants getting a full course of antenatal corticosteroids increased from 67.7% in 1996 to 91.4% in 2008 (p < 0.001). Surfactant was given more frequently (24.8% in 1996 compared to 40.1% in 2008, p < 0.001) and the frequency of mechanical ventilation remained stable by about 43%. However, the use of CPAP therapy increased considerably from 43% to 73.2% (p < 0.001). Some of the typical neonatal pathologies like bronchopulmonary dysplasia, necrotising enterocolitis and intraventricular haemorrhage decreased significantly (p ≤ 0.02) whereas others like patent ductus arteriosus and respiratory distress syndrome increased (p < 0.001).
Conclusions
Over the 12-year observation period, the number of VP- and VLBW infants increased significantly. An unchanged overall mortality rate and an increase of survivors free of major complication resulted in a considerable net gain in infants with potentially good outcome.
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