Actuarial survival of a large Canadian cohort of preterm infants

Abstract

Background: The increased survival of preterm and very low birth weight infants in recent years has been well documented but continued surveillance is required in order to monitor the effects of new therapeutic interventions. Gestation and birth weight specific survival rates most accurately reflect the outcome of perinatal care. Our aims were to determine survival to discharge for a large Canadian cohort of preterm infants admitted to the neonatal intensive care unit (NICU), and to examine the effect of gender on survival and the effect of increasing postnatal age on predicted survival.

Neonatal and infant outcome in boys and girls born very prematurely

“…All four indices of lung profile showed that the male fetuses had less mature lungs than the females by approximately 1 wk (9). In a more recent and large cohort of births below 31 wk in Canada, Jones et al showed the familiar male/female differences in acute outcomes but interestingly showed that differences in survival were only apparent for infants born at 24-wk gestation (13). This is consistent with the thesis that the relative male immaturity determines the excess mortality observed in very preterm infants.…”

“…The now routine use of antenatal corticosteroids and postnatal surfactant have been associated with a substantial improvement in survival (8,12,13). It may be therefore that there are less marked differences in outcome for boys and girls following the introduction of these treatments.…”

İstanbul'da Bi̇r Referans Hastanesi̇ni̇n Üçüncü Basamak Yoğun Bakim Üni̇tesi̇nde İzlenen Çok Düşük Doğum Ağirlikli Yeni̇doğanlarin Kli̇ni̇k Seyri̇

“…Gebelik haftası 27-30 hafta arasında olan bebeklerin ölüm oranları diğer çalışmalara göre halen yük-sekti. Finlandiya'da bu oran %20, Kanada'da %5 iken bizim çalışmamızda %41.6 bulundu [6,10].…”

“…Ancak, preterm yenidoğanların sağ kalım ve klinik seyri farklı bölge ve hastanelerde çeşit-lilik göstermektedir. Pratik hayatta yapılan uygulamaların etkinliğini moniterize etmek için bu bebeklere ait güncel sürveyans çalışmalarını yapmak esastır [6]. Bu nedenle gelişmekte olan ülkelerde her bir bölge ve hastanenin kendisine ait preterm bebeklerin klinik seyrine dair verilerini değerlendirmesi önemlidir.…”

Parental authority, patient's best interest and refusal of resuscitation at borderline gestational age

“…3 Published data from a large Canadian cohort show similar results. 4 Survival in recent years may have increased somewhat for the lowest gestational ages. At Yale-New Haven Children's Hospital, combined data for 2003 and 2004 showed survival to discharge was 38% for infants born at 23 completed weeks, 66% at 24 weeks and 71% at 25 weeks.…”