Changes in Perinatal Care and Outcomes in Newborns at the Limit of Viability in Spain: The EPI-SEN Study

Abstract

Background: Advances in perinatal care can influence morbidity and mortality in newborns at the limit of viability. Knowledge of these changes over time may help improve clinical decision making, optimize resource allocation and increase quality of care. Objectives: To evaluate the influence on morbidity and mortality of changes introduced in the perinatal care of preterm infants (22-26 weeks' gestational age, GA) in Spain between two consecutive periods (2002-2006 and 2007-2011). Methods: An analysis of prospectively collected data in a national database network (SEN1500) was performed. All live newborn infants of 22-26 weeks' GA born in or transferred to referral centers of the SEN1500 network in the first 28 days of life were included. Perinatal interventions, clinical management, neonatal morbidity, and survival until hospital discharge were retrieved. Results: A total of 5,470 newborns were included (2,533 and 2,937 in each period, respectively). The major changes introduced during the second period were as follows: (1) lower proportion of extramural births (11.0 vs. 8.9%, p = 0.01), (2) increase in antenatal steroids (69.5 vs. 80.8%, p < 0.001), (3) delivery by C-section (41.8 vs. 48.3%, p < 0.001) and (4) use of CPAP during resuscitation (7.8 vs. 20.7%, p < 0.001). Death in the delivery room decreased from 5.1 to 3.2% (p < 0.001). Survival increased from 49.9 to 57.9% (p < 0.001), and survival without major morbidity increased from 18.1 to 21.2% (p = 0.006). Conclusions: During the second period, a greater attachment to practices proven to have a beneficial impact on survival and reduction of morbidity in the extremely preterm infant was noted, and survival and survival without major morbidity increased. A more conservative approach was detected for newborns of 22 weeks' GA.

Survival and Neurodevelopmental Outcomes of Preterms Resuscitated With Different Oxygen Fractions

“…Survival of extremely preterm infants has improved in recent years; however, both neurodevelopmental and/or sensorial impairment still affect a substantial number of survivors. 22 Term infants resuscitated with 100% oxygen exhibited prolonged oxidative stress after birth and had increased mortality. 4,23 Moreover, epidemiologic studies have shown that exposure to oxygen even for brief periods of time immediately after birth is associated with an increased incidence of childhood cancer.…”

Effect of Neonatal Intensive Care Unit Hospitalization on Incidence of Attention Deficit Hyperactivity Disorder in Preschool Children

“…Fischer's exact test showed that the incidence of ADHD is more frequent in boys (22%) than girls (19%) (P value = 0.038). The test also showed that there was no significant difference between six-and seven-year-old children in terms of ADHD (P value 2 Iran J Psychiatry Behav Sci. 2017; 11(1):e5394.…”

“…Following the advances in perinatal care, an increasing number of preterm infants reach childhood (2). Negative effects of preterm birth on neurodevelopmental and psychiatric development of children and adolescents have been well documented (3)(4)(5)(6)(7)(8).…”

Teamwork en medicina: una necesidad

“…García-Muñoz y colaboradores reportaron una incidencia de sepsis tardía de 50,5% en los menores de 26 semanas y estuvo asociada con la prolongada estancia hospitalaria, similar a nuestros resultados (41,05%) para la sepsis tardía (17) .…”