The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain

Abstract

Background: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. Objectives: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). Methods: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants <23⁰ or >34⁶ weeks of gestational age (GA) were excluded. Results: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of “outborn” patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (23⁰ to 26⁶ weeks' GA) from 26.6 to 31.6% (p < 0.001). Conclusions: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.

Factors Associated with Survival and Survival without Major Morbidity in Very Preterm Infants in Two Neonatal Networks: SEN1500 and NEOCOSUR

“…Probably some postnatal interventions, such as oxygen administration and invasive mechanical ventilation, together with the development of some morbidities, such as a patent ductus arteriosus, bacterial sepsis, or NEC, could dampen the beneficial effect of steroids on the combined outcome. This is interesting, since we had recently showed that despite an increase in the use of antenatal steroids and a gentler respiratory support during the last decade in Spain, an increase in survival without BPD was only detected among the most immature patients (<27 weeks of GA) [20]. In addition to these factors, the present study shows that providing a less invasive management in the delivery room, with a lower rate of intubations, chest compressions, and/or epinephrine administration, independently increased the probability of survival and survival without major morbidity (Table 3).…”

The Impact of Postnatal Systemic Steroids on the Growth of Preterm Infants: A Multicenter Cohort Study

“…Survival for the most immature patients (<26 weeks GA) increased from 26.6% to 36.6% ( p < 0.001). Changes in nutritional practices were not systematically collected [25]. Data about the type of steroid, number of cycles, route of administration, dosage schedule and duration of therapy were not available in the original database.…”

Impact of surfactant administration through a thin catheter in the delivery room: A quality control chart analysis coupled with a propensity score matched cohort study in preterm infants

“…BPD is still the most frequent adverse outcome for infants born less than 30 weeks GA, despite the introduction of antenatal steroids, postnatal surfactant, modern respiratory care, and improved nutrition [22,23]. The prevalence of BPD has increased, along with the increase in survival of infants born before 28 weeks GA [24], with rates that remain high, approximately 40%, over the last few years [25].…”