Survival and causes of death in extremely preterm infants in the Netherlands

Abstract

ObjectiveIn the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks’ gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.DesignNational cohort study, using data from the Netherlands Perinatal Registry.PatientsThe study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.Main outcome measuresSurvival to discharge, as well as cause and timing of death.ResultsAfter guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks’ GA (27%–69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%–34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011–2014 to 23% in 2015–2017, p=0.006).ConclusionsImplementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks’ GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.

Deaths in a Modern Cohort of Extremely Preterm Infants From the Preterm Erythropoietin Neuroprotection Trial

“…Mortality was also lower and time to death longer in our cohort than reported in a recent cohort from the Netherlands. 22 Mortality details have implications for parental guidance: in 1996 one could tell parents that if their child survived 3 days, the chances for ongoing survival were high, whereas in our present cohort, the period of uncertainty regarding ultimate outcome is prolonged and has the potential to increase parental stress.…”

“…Overall mortality was lower than expected, at 12% within the initial hospitalization, with an additional 1% who died between 9 and 25 months after birth. 9,[21][22][23] As expected, the risk of death was highest in the least mature infants; however, the ability of GA to who survived to be enrolled, so this difference is accentuated. Mortality was also lower and time to death longer in our cohort than reported in a recent cohort from the Netherlands.…”

The Edge of Perinatal Viability: Understanding the Dutch Position

“…However, preferences concerning the upper threshold for offering comfort care still greatly diverge, as well as practices such as offering a cesarean section and providing cardiopulmonary resuscitation (13). Finally, a recent study by van Beek et al shows that the implementation of the 2010 guideline "resulted in increased neonatal intensive care unit admission rates and postnatal survival" (14). Although these results are useful to reflect on the guideline, more follow-up research on longer term outcomes is required.…”

Nationwide inventory on retinopathy of prematurity screening in the Netherlands

“…15 Therefore, comparing incidences to other countries is challenging as neonatal policies, survival and screening criteria may differ. Survival for infants born at 24 weeks (as % of live borns) was 34.4% in the Netherlands in the period 2011-2017 16 . Other similar national population-based cohorts report however survival rates varying from 31% to 67% in 24-week infants.…”

“…Although survival of extremely premature infants in the Netherlands is still in the lower range compared with other high income countries, with continuously improving survival of these neonates, awareness of concomitant conditions such as (severe) ROP remains crucial. 16 Second, surprisingly the NEDROP 1 revealed that the ETROP criteria, 7 which apply since their publication in 2004, were not yet fully implemented in the Netherlands. 4 The former guideline dating from 1997 did not include a directive on ROP treatment, therefore possibly, utilisation into practice stayed behind.…”