Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks

Fecha de publicación: 01/12/2017

Autores de IIS La Fe

Máximo Vento Torres

Autor

Participantes ajenos a IIS La Fe

Helenius, Kjell
Sjörs G
Shah, Prakesh S.
Modi, Neena
Reichman, Brian
Morisaki, Naho
Kusuda, Satoshi
Lui, Kei
Darlow, Brian A.
Bassler, Dirk
Håkansson S
Adams, Mark
Rusconi, Franca
Isayama, Tetsuya
Lee, Shoo K.
Lehtonen, Liisa
International Network for Evaluating Outcomes (iNeo) of Neonates

Grupos

Perinatología

Leader

Máximo Vento Torres

Abstract

OBJECTIVES: To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHODS: A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. RESULTS: Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. CONCLUSIONS: The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.

Datos de la publicación

ISSN/ISSNe:: 0031-4005, 1098-4275
Tipo:: Article
Páginas:: -
DOI:: 10.1542/peds.2017-1264
PubMed:: 29162660
Factor de Impacto:: 3,337 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Helenius, Kjell:: Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland

Department of Clinical Medicine, University of Turku, Turku, Finland

Turku Univ Hosp, Dept Pediat & Adolescent Med, Kiinamyllynkatu 4-8, Turku 20521, Finland

Univ Turku, Dept Clin Med, Turku, Finland
Sjörs G:: National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
Shah, Prakesh S.:: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

Univ Toronto, Dept Pediat, Toronto, ON, Canada

Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada

Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada
Modi, Neena:: United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, and Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom

Imperial Coll London, Chelsea & Westminster Hosp, United Kingdom Neonatal Collaborat, Neonatal Data Anal Unit, London, England

Imperial Coll London, Chelsea & Westminster Hosp, Sect Neonatal Med, Dept Med, London, England
Reichman, Brian:: Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel

Sheba Med Ctr, Gertner Inst Epidemiol & Hlth Policy Res, Tel Hashomer, Israel
Morisaki, Naho:: Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan

Natl Ctr Child Hlth & Dev, Dept Social Med, Tokyo, Japan
Kusuda, Satoshi:: Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan

Tokyo Womens Med Univ, Maternal & Perinatal Ctr, Tokyo, Japan
Lui, Kei:: Royal Hospital for Women, and National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Randwick, Australia

Royal Hosp Women, Randwick, NSW, Australia

Univ New South Wales, Natl Perinatal Epidemiol & Stat Unit, Randwick, NSW, Australia
Darlow, Brian A.:: Department of Pediatrics, University of Otago, Christchurch, New Zealand

Univ Otago, Dept Pediat, Christchurch, New Zealand
Bassler, Dirk:: Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Zurich, Switzerland
Håkansson S:: National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
Adams, Mark:: Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

Univ Zurich, Univ Hosp Zurich, Dept Neonatol, Zurich, Switzerland
Vento, Maximo:: Instituto de Investigación. Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain

and

Instituto de Investigación. Hlth Res Inst La Fe, Ave Fernando Abril Martorell, Valencia, Spain
Rusconi, Franca:: TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy and Regional Health Agency of Tuscany, Florence, Italy

Meyer Childrens Univ Hosp, TIN Toscane Online, Unit Epidemiol, Florence, Italy

Reg Hlth Agcy Tuscany, Florence, Italy
Isayama, Tetsuya:: Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada

Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada
Lee, Shoo K.:: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

Univ Toronto, Dept Pediat, Toronto, ON, Canada

Mt Sinai Hosp, Maternal Infant Care Res Ctr, Toronto, ON, Canada

Mt Sinai Hosp, Dept Pediat, Toronto, ON, Canada
Lehtonen, Liisa:: Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland

Department of Clinical Medicine, University of Turku, Turku, Finland

Turku Univ Hosp, Dept Pediat & Adolescent Med, Kiinamyllynkatu 4-8, Turku 20521, Finland

Univ Turku, Dept Clin Med, Turku, Finland