Dynamics of neonatal indicators of the Kyiv Perinatal Center over 10 years of activity

Abstract

Prematurity is the leading cause of early neonatal death and child morbidity. Numerous attempts to prevent premature births have not led to a significant decrease in their rate in the world, therefore it is important to organize the medical care for premature babies during childbirth and in the first minutes of life. Kyiv Perinatal Center has many years of experience in providing care to premature newborns, which is implemented in cooperation with obstetrician-gynecologists and neonatologists.The objective: to assess the dynamics of neonatal indicators in the Kyiv Perinatal Center for 2012–2022.Materials and methods. The dynamics of neonatal indicators (early neonatal mortality, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), leukomalacia) were assessed quarterly in newborns with a gestational age of 22–34 weeks for 2012–2022 using the linear regression method.The impact of implemented technologies – intranatal magnesium therapy in 2014 and the method of stabilizing a newborn on a pulsating umbilical cord in 2016 on the indicated indicators was also studied. Therefore, 3 time periods were formed – 2012–2013, 2014–2015, and 2016–2022 years.For quantitative indicators, the median and interquartile range were calculated. The Kruskal–Wallis test was used for comparison. Aposteriori comparisons were made according to Dunn’s test.Results. During 10 years of work at the Perinatal Center, a decreased rate of early neonatal mortality among premature newborns was determined from 12.7±2.5% to 1.7±0.9% (р<0.05), while the rate of the second period was significantly different from the first one, and the second period – from the third one, that is, it was influenced by the wide implementation of both intranatal magnesium therapy and stabilization on an intact umbilical cord.A tendency towards a decrease in the frequency of IVH was established during the second period – from 12.0±3.1% to 5.6±1.5%, during the third one – to 2.0±1.3% (p<0.05), i.e. both interventions had a positive effect on this indicator. A similar pattern was found for NEC and leukomalacia, the frequency of which decreased from 9.3±1.7% to 2.0±0.9% (p<0.05) and from 3.6±1.3% to 0.1±0.2% (p<0.05), respectively.Instead, a decrease in the frequency of BPD and the need for invasive ventilation was found only for the third time interval – from 4.0±0.9% to 1.1±0.7% (p<0.05) and 13.8±2.8% to 6.5±2.0% (p<0.05), respectively. To prevent these complications, the technique of stabilizing the newborn on an intact umbilical cord is effective.Conclusions. In the process of activity of the Kyiv Perinatal Center, a statistically significant decrease in the rate of early neonatal mortality in premature births was found (from 12.7±2.5% in 2012 to 1.7±0.9% in 2022), as well as the frequency of the main complications of prematurity – intraventricular hemorrhages, necrotizing enterocolitis, bronchoalveolar dysplasia, leukomalacia. A decrease in the frequency of invasive pulmonary ventilation of premature newborns was also determined.According to the linear regression method, a significant effect of the widespread introduction of magnesium therapy on the rate of early neonatal mortality, the frequency of intraventricular hemorrhages, necrotizing enterocolitis, and leukomalacia was demonstrated, as well as the significant importance of the widespread implementation of the technology of stabilizing the newborn on an intact umbilical cord on the indicator of early neonatal mortality, the frequency of necrotizing enterocolitis, leukomalacia and bronchopulmonary dysplasia