Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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Changes of Mortality and Morbidity of Very Low Birth Weight Infants after Neonatal Intensive Care Unit Strategy Alteration in a Single Center: Comparison with 2015 Korean Neonatal Network Report

  • Jung, Seung Mi (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Seok, Min Jeong (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Chun, Ji Yong (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Sung, Tae-Jung (Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University Medical Center)
  • Received : 2017.09.18
  • Accepted : 2017.10.31
  • Published : 2018.02.28
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Abstract

Purpose: The purpose of this study was to investigate the outcome after changes in the treatment strategies for very low birth weight infant (VLBWI) in a single neonatal intensive care unit (NICU) center. Methods: We performed a retrospective review of 300 VLBWI born from 1st January 2010 to 31th December 2016. We compared the outcomes including survival rate, birth weight (BW), gestational age (GA), and morbidities between period I (2010-2013, P-I) and period II (2014-2016, P-II). Results: The average survival rate was not different between P-I and P-II. However, the survival rate of ${\leq}24$ weeks' GA, 25 weeks' GA, 26 weeks' GA were 57%, 69%, 93% respectively in P-II and 31%, 59%, 87% in P-I respectively. The survival rate of infants with birth weight <500 g, 500-749 g, 750-999 g were 100%, 55%, 90% respectively in P- II and 50%, 24%, 80%, respectively in P-I. The incidence of bronchopulmonary dysplasia (BPD) was higher in P-II than in P-I (P=0.012) and moderate-to-severe BPD was also higher in P-II (P=0.004). Incidence of patent ductus arteriosus (PDA) with treatment, necrotizing enterocolitis (stage ${\geq}2$), and abnormal brain sonography were significantly lower in P-II (P=0.027, P=0.032, P=0.005). Incidences of retinopathy of prematurity (ROP) with laser treatment and early sepsis were not different. Conclusion: The survival rate and complications of VLBWI were improved in period II, especially in less than 750 g and below 26 weeks, except incidence of BPD. Changes of NICU strategies were effective to improve mortality and morbidity in VLBWI.

Keywords

References

  1. The Executive Committee of Korean Neonatal Networt. 2015 Korean Neonatal Network Annual Report: Korean Centers for Disease Control and Prevention, 2016.
  2. Kim KS, Bae CW. Trends in survival rate for very low birth weight infants and extremely low birth weight infants in Korea, 1967-2007. Korean J Pediatr 2008;51:237-42. https://doi.org/10.3345/kjp.2008.51.3.237
  3. Matthews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep 2013;62:1-26.
  4. Kim MH. Changes in birth rates of low birth weight and premature infants in Korea over the past 7 years. Korean J Pediatr 2008;51:233-6. https://doi.org/10.3345/kjp.2008.51.3.233
  5. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008;371:75-84. https://doi.org/10.1016/S0140-6736(08)60074-4
  6. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002;110:143-51. https://doi.org/10.1542/peds.110.1.143
  7. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al; NICHD Neonatal Research Network. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 2001;107:e1. https://doi.org/10.1542/peds.107.1.e1
  8. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birth weight infants. Am J Obstet Gynecol 2007;196:147.e1-8. https://doi.org/10.1016/j.ajog.2006.09.014
  9. Kusuda S, Fujimura M, Sakuma I, Aotani H, Kabe K, Itani Y, et al; Neonatal Research Network, Japan. Morbidity and mortality of infants with very low birth weight in Japan: a center variation. Pediatrics 2006;118:e1130-8. https://doi.org/10.1542/peds.2005-2724
  10. Shim JW, Kim MJ, Kim EK, Park HK, Song ES, Lee SM, et al; Committee on Data Collection and Statistical Analysis, The Korean Society of Neonatology. The impact of neonatal care resources on regional variation in neonatal mortality among very low birth weight infants in Korea. Pediatr Perinat Epidemiol 2013;27:216-25. https://doi.org/10.1111/ppe.12033
  11. Lee HH, Kim TY, Shin SH, Sung TJ. Changes in the outcomes of neonatal intensive care unit at a single center over 12 years. Korean J Pediatr 2009;52:881-7. https://doi.org/10.3345/kjp.2009.52.8.881
  12. Chang YS, Park WS. Strategies to overcome the limit of viability of microprimie. Neonatal Med 2013;20:258-67. https://doi.org/10.5385/nm.2013.20.3.258
  13. Chang YS, Ahn SY, Park WS. The establishment of the Korean Neonatal Network (KNN). Neonatal Med 2013;20:169-78. https://doi.org/10.5385/nm.2013.20.2.169
  14. Zonnenberg I, de Waal K. The definition of a haemodynamic significant duct in randomized controlled trials: a systematic literature review. Acta Paediatr 2012;101:247-51. https://doi.org/10.1111/j.1651-2227.2011.02468.x
  15. Dempsey EM, Al Hazzani F, Barrington KJ. Permissive hypotension in the extremely low birthweight infant with signs of good perfusion. Arch Dis Child Fetal Neonatal Ed 2009;94:F241-4 https://doi.org/10.1136/adc.2007.124263
  16. Lee J, Kim HS, Jung YH, Choi KY, Shin SH, Kim EK, et al. Oropharyngeal colostrum administration in extremely premature infants: an RCT. Pediatrics 2015;135:e357-66. https://doi.org/10.1542/peds.2014-2004
  17. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9. https://doi.org/10.1164/ajrccm.163.7.2011060
  18. Pi SY. Manual of neonatal care. 2nd ed. Seoul: The Korean Society of Neonatology, 2008:184-9, 247-8, 235-40, 452-5, 350-4.
  19. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less 1,500 gm. J Pediatr 1978;92:529-34. https://doi.org/10.1016/S0022-3476(78)80282-0
  20. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutics decisions based upon clinical staging. Ann Surg 1978;187:1-7. https://doi.org/10.1097/00000658-197801000-00001
  21. Smith PB, Ambalavanan N, Li L, Cotten CM, Laughon M, Walsh MC, et al. Approach to infants born at 22 to 24 weeks' gestation: relationship to outcomes of more-mature infants. Pediatrics 2012;129:e1508-16. https://doi.org/10.1542/peds.2011-2216
  22. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, et al. Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2010;126:e1400-13. https://doi.org/10.1542/peds.2010-2972E
  23. Hellstrom A, Smith LE, Dammann O. Retinopathy of prematurity. Lancet 2013;382:1445-57. https://doi.org/10.1016/S0140-6736(13)60178-6
  24. Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2014:CD000503. doi: 10.1002/14651858.CD000503.pub3.
  25. Barton L, Hodgman JE, Pavlova Z. Causes of death in the extremely low birth weight infant. Pediatrics 1999;103:446-51. https://doi.org/10.1542/peds.103.2.446
  26. Stranak Z, Velebil P, Stembera Z. Changes in causes of mortality in very low birth weight neonates. Ceska Gynekol 2002;67 Suppl 1:46-9.
  27. Lapillonne A, Griffin IJ. Feeding preterm infants today for later metabolic and cardiovascular outcomes. J Pediatr 2013;162:S7-16. https://doi.org/10.1016/j.jpeds.2012.11.048
  28. Jeon GW, Park SE, Choi CW, Hwang JH, Chang YS, Park WS. The effects of early enteral feeding in extremely low birthweight infants. Korean J Pediatr 2005;48:711-5.
  29. Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Vanhole C, Palmer CR, van Weissenbruch, et al. Early insulin therapy in very-low-birth-weight infants. N Engl J Med 2008;359:1873-84. https://doi.org/10.1056/NEJMoa0803725