Temporal trends of care practices, morbidity, and mortality of extremely preterm infants over 10-years in South Wales, UK

Abstract

Contemporary outcome data of preterm infants are essential to commission, evaluate and improve healthcare resources and outcomes while also assisting professionals and families in counselling and decision making. We analysed trends in clinical practice, morbidity, and mortality of extremely preterm infants over 10 years in South Wales, UK. This population-based study included live born infants < 28 weeks of gestation in tertiary neonatal units between 01/01/2007 and 31/12/2016. Patient characteristics, clinical practices, mortality, and morbidity were studied until death or discharge home. Temporal trends were examined by adjusted multivariable logistic regression models and expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). A sensitivity analysis was conducted after excluding infants born at < 24 weeks of gestation. In this population, overall mortality for infants after live birth was 28.2% (267/948). The odds of mortality (aOR 0.93, 95% CI [0.88, 0.99]) and admission to the neonatal unit (0.93 [0.87, 0.98]) significantly decreased over time. Non-invasive ventilation support during stabilisation at birth increased significantly (1.26 [1.15, 1.38]) with corresponding decrease in mechanical ventilation at birth (0.89 [0.81, 0.97]) and following admission (0.80 [0.68–0.96]). Medical treatment for patent ductus arteriosus significantly decreased over the study period (0.90 [0.85, 0.96]). The incidence of major neonatal morbidities remained stable, except for a reduction in late-onset sepsis (0.94 [0.89, 0.99]). Gestation and centre of birth were significant independent factors for several outcomes. The results from our sensitivity analysis were compatible with our main results with the notable exception of death after admission to NICU (0.95 [0.89, 1.01]). There were significant improvements in survival and reduction of late-onset sepsis of extreme preterm infants in South Wales between 2007 and 2016. The sensitivity analysis suggests that some of the temporal changes observed were driven by improved outcomes in the most preterm of infants. Clinical practices related to respiratory support have changed but significant variations in clinical practices and outcomes between centres remain unexplained. The adoption of regional evidence-based clinical guidelines is likely to improve outcomes and reduce variation.

Trends in bronchopulmonary dysplasia and respiratory support among extremely preterm infants in China over a decade

“…Despite decreasing mortality, there was less improvement in BPD. Most recent studies examining secular trends in BPD have reported unchanged or increasing rates over time 4,23,24 . In a large international cohort from 11 high‐income countries, investigators found that the rate of BPD among very preterm infants increased between 2007 and 2015 in most collaborative countries, except Canada and Finland 5 .…”

“…Most recent studies examining secular trends in BPD have reported unchanged or increasing rates over time. 4,23,24 In a large international cohort from 11 high-income countries, investigators found that the rate of BPD among very preterm infants increased between 2007 and 2015 in most collaborative countries, except Canada and Finland. 5 A retrospective cohort study in Spain revealed that BPD-free survival remained constant over the last 10 years and even worsened in the group with the lowest GA (23-25 weeks).…”

Respiratory Management of the Preterm Infant: Supporting Evidence-Based Practice at the Bedside

“…Avoiding MV, if possible, and optimizing noninvasive respiratory support in preterm infants reduces lung injury and improves neonatal outcomes [ 16 , 17 ].…”

The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review and network meta-analysis

“…(13) However, even with the increasing usage of antenatal corticosteroids and surfactant for lung maturation, (14) the reported incidence of IVH has not consistently decreased. (15)(16)(17)(18) There have been many trials and reviews investigating the effectiveness of preventative interventions. (3,8,13) Interventions can be given antenatally to the mother, or postnatally to the infant after birth.…”