Factors Associated with Survival and Survival without Major Morbidity in Very Preterm Infants in Two Neonatal Networks: SEN1500 and NEOCOSUR

Abstract

Introduction: Very low-birth weight (VLBW) infants represent a high-risk population for morbidity and mortality in the neonatal period. Variability in practices and outcomes between centers has been acknowledged. Multicenter benchmarking studies are useful to detect areas of improvement and constitute an interesting research tool. Objectives: The aim of the study was to determine the perinatal variables and interventions associated with survival and survival without major morbidity in VLBW infants and compare the performance of 2 large networks. Methods: This is a prospective study analyzing data collected in 2 databases, the Spanish SEN1500 and the South American NEOCOSUR networks, from January 2013 to December 2016. Inborn patients, from 240 to 306 weeks of gestational age (GA) were included. Hazard ratios for survival and survival without major morbidity until the first hospital discharge or transfer to another facility were studied by using Cox proportional hazards regression. Results: A total of 10,565 patients, 6,120 (57.9%) from SEN1500 and 4,445 (42.1%) from NEOCOSUR, respectively, were included. In addition to GA, birth weight, small for gestational age (SGA), female sex, and multiple gestation, less invasive resuscitation, and the network of origin were significant independent factors influencing survival (aHR [SEN1500 vs. NEOCOSUR]: 1.20 [95% CI: 1.15–1.26] and survival without major morbidity: 1.34 [95% CI: 1.26–1.43]). Great variability in outcomes between centers was also found within each network. Conclusions: After adjusting for covariates, GA, birth weight, SGA, female sex, multiple gestation, less invasive resuscitation, and the network of origin showed an independent effect on outcomes. Determining the causes of these differences deserves further study.

An assessment of improved outcomes using low-cost bubble CPAP in very low birthweight neonates in a Nigerian tertiary hospital

“…Studies have shown that ELBW is associated with significantly high mortality with survival decreasing as gestational age reduced. [20][21][22][23][24][25] After controlling for the effect of gestational age and birth weight on survival, our study demonstrated a 74% reduction in the odds of mortality in preterms delivered <1500g in the post-bCPAP era. This is in contrast to a study in Kenya where, following bCPAP implementation, survival to discharge improved from 61% to 85%.…”

“…Studies have shown that ELBW is associated with significantly high mortality with survival decreasing as gestational age reduced. 20–25…”

Incidence and Predictors of Preterm Mortality in Ethiopia: A Systematic Review and Meta-analysis

“…Male neonates had 1.43 higher hazards of mortality compared to females; which is contradictory to a finding of a study in Spain. 40 Preterm neonates having fifth minute Apgar score <7 had almost two times higher hazards of death compared to those having ≥7, which is supported by studies in Spain and Rwanda. 40,41 Furthermore, compared to their counterparts, preterm neonates with birth asphyxia had twice the risk of dying; which is supported by studies in Uganda and Nigeria.…”

“…Preterm neonates having fifth minute Apgar score <7 had almost two times higher hazards of death compared to those having ≥7, which is supported by studies in Spain and Rwanda. 40, 41 Furthermore, compared to their counterparts, preterm neonates with birth asphyxia had twice the risk of dying; which is supported by studies in Uganda and Nigeria. 37, 39 This might be due to oxygen deficit during delivery leading to severe hypoxia of vital organs and becoming a double burden, which is an implication for close labor follow-up.…”

“…Male neonates had 1.43 higher hazards of mortality compared to females; which is contradictory to a finding of a study in Spain. 40…”