Ten-year trend of care practices, morbidities and survival of very preterm neonates in the Malaysian National Neonatal Registry: a retrospective cohort study

Abstract

ObjectivesTo determine a 10-year trend of survival, morbidities and care practices, and predictors of in-hospital mortality in very preterm neonates (VPTN, gestation 22 to <32 weeks) in the Malaysian National Neonatal Registry.DesignRetrospective cohort study.Setting43 Malaysian neonatal intensive care units.Patients29 010 VPTN (without major malformations) admitted between 1 January 2009 and 31 December 2018.Main outcome measuresCare practices, survival, admission hypothermia (AH, <36.5°C), late-onset sepsis (LOS), pneumothorax, necrotising enterocolitis grade 2 or 3 (NEC), severe intraventricular haemorrhage (sIVH, grade 3 or 4) and bronchopulmonary dysplasia (BPD).ResultsDuring this 10-year period, there was increased use of antenatal steroid (ANS), lower segment caesarean section (LSCS) and early continuous positive airway pressure (eCPAP); but decreased use of surfactant therapy. Survival had increased from 72% to -83.9%. The following morbidities had decreased: LOS (from 27.9% to 7.1%), pneumothorax (from 6.0% to 2.7%), NEC (from 8.1% to 4.7%) and sIVH (from 12.2% to 7.5%). However, moderately severe AH (32.0°C–35.9°C) and BPD had increased. Multiple logistic regression analyses showed that lower birth weight, no ANS, no LSCS, admission to neonatal intensive care unit with <100 VPTN admissions/year, no surfactant therapy, no eCPAP, moderate and severe AH, LOS, pneumothorax, NEC and sIVH were significant predictors of mortality.ConclusionSurvival and major morbidities had improved modestly. Failure to use ANS, LSCS, eCPAP and surfactant therapy, and failure to prevent AH and LOS increased risk of mortality.

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis

“…Ten studies assessed the presence of proven EOS in neonates with any stage ROP compared with neonates without ROP, with sample sizes ranging from 74 to 14,008 ( Supplementary Table S1 [available in the online version]). 24 25 26 27 28 29 30 31 32 33…”

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis

“…Ten studies assessed the presence of proven EOS in neonates with any stage ROP compared with neonates without ROP, with sample sizes ranging from 74 to 14,008 ( Supplementary Table S1 [available in the online version]). 24 25 26 27 28 29 30 31 32 33…”

Postnatal cytomegalovirus infection and bronchopulmonary dysplasia in very low birth weight infants: Influence of diagnostic criteria and viral load in a propensity score–matched cohort study

“…The enhancement of medical interventions has led to an increase in the survival rate of preterm infants, but concurrently with an increase in the prevalence of BPD [ 25 – 27 ]. As our understanding of the pathophysiology and management of BPD have evolved, the diagnostic criteria have moved from the widely used but less specific 2001 NICHD definition toward more contemporary standards (2018 NICHD and 2019 NRN criteria) that better reflect modern and new non-invasive respiratory support modalities, in particular, the use of heated humidified high-flow nasal cannula, and are more predictive of long-term outcomes [ 28 – 30 ].…”

Survival and morbidity in very preterm infants in Shenzhen: a multi-center study

“…Thus, this finding may not necessarily imply higher levels of sepsis control at the investigated NICUs and warrants further investigation. In a French study that included VPIs, higher prevalence of severe IVH (5.3%) and lower prevalence of severe ROP (1.2%) were found (23). In another cohort study from China, the prevalence of severe ROP and severe brain injury is 10.4% and 4.3%, respectively (4).…”

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis

“…Ten studies assessed the presence of proven EOS in neonates with any stage ROP compared with neonates without ROP, with sample sizes ranging from 74 to 14,008 ( Supplementary Table S1 [available in the online version]). 24 25 26 27 28 29 30 31 32 33…”

Postnatal cytomegalovirus infection and bronchopulmonary dysplasia in very low birth weight infants: Influence of diagnostic criteria and viral load in a propensity score–matched cohort study

“…The enhancement of medical interventions has led to an increase in the survival rate of preterm infants, but concurrently with an increase in the prevalence of BPD [ 25 – 27 ]. As our understanding of the pathophysiology and management of BPD have evolved, the diagnostic criteria have moved from the widely used but less specific 2001 NICHD definition toward more contemporary standards (2018 NICHD and 2019 NRN criteria) that better reflect modern and new non-invasive respiratory support modalities, in particular, the use of heated humidified high-flow nasal cannula, and are more predictive of long-term outcomes [ 28 – 30 ].…”

Survival and morbidity in very preterm infants in Shenzhen: a multi-center study

“…Thus, this finding may not necessarily imply higher levels of sepsis control at the investigated NICUs and warrants further investigation. In a French study that included VPIs, higher prevalence of severe IVH (5.3%) and lower prevalence of severe ROP (1.2%) were found (23). In another cohort study from China, the prevalence of severe ROP and severe brain injury is 10.4% and 4.3%, respectively (4).…”

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis

“…Ten studies assessed the presence of proven EOS in neonates with any stage ROP compared with neonates without ROP, with sample sizes ranging from 74 to 14,008 ( Supplementary Table S1 [available in the online version]). 24 25 26 27 28 29 30 31 32 33…”

Postnatal cytomegalovirus infection and bronchopulmonary dysplasia in very low birth weight infants: Influence of diagnostic criteria and viral load in a propensity score–matched cohort study

“…The enhancement of medical interventions has led to an increase in the survival rate of preterm infants, but concurrently with an increase in the prevalence of BPD [ 25 – 27 ]. As our understanding of the pathophysiology and management of BPD have evolved, the diagnostic criteria have moved from the widely used but less specific 2001 NICHD definition toward more contemporary standards (2018 NICHD and 2019 NRN criteria) that better reflect modern and new non-invasive respiratory support modalities, in particular, the use of heated humidified high-flow nasal cannula, and are more predictive of long-term outcomes [ 28 – 30 ].…”

Survival and morbidity in very preterm infants in Shenzhen: a multi-center study

“…Thus, this finding may not necessarily imply higher levels of sepsis control at the investigated NICUs and warrants further investigation. In a French study that included VPIs, higher prevalence of severe IVH (5.3%) and lower prevalence of severe ROP (1.2%) were found (23). In another cohort study from China, the prevalence of severe ROP and severe brain injury is 10.4% and 4.3%, respectively (4).…”