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MISCELLANEA 1
Year : 2004  |  Volume : 7  |  Issue : 2  |  Page : 58

Improved outcomes for very low birthweight infants: Evidence from New zealand national population based data


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Advances in both perinatal and neonatal care over the past two decades mean that increasing numbers of very preterm and very low birthweight (birth weight < 1500g; VLBW) inf ants are surviving. In part this success has itself led to a greater willingness by obstetricians to intervene at earlier gestations with ensuing increases in the numbers of VLBW infants admitted to neonatal intensive care units (NICUs) . In New Zealand, researchers like BA Darlow, AE Cust and DA Donoghue, on behalf of the Australian and New Zealand Neonatal Network (ANZNN), decided from a good study (Arch Dis Child Fetal Neonatal Ed 2003; 88: F23-F28) compare the survival and short term morbidity of all New Zealand very low birthweight (VLBW) infants born in two epochs, 1986 and 1998- 1999. Setting: All level Ill and level II neonatal intensive care units (N I CUs) in New Zealand . Mehods: In 1986, data were prospectively collected for a study of retinopathy of prematurity (ROP). In -1999, prospective data were collected by the Australian and New Zealand Neonatal Network (ANZNN) Both cohorts included all VLBW infants born during the calendar year an d admitted to a NICU. Data were collected from birth until discharge home or death . Results: More VLBW infants were admitted for care in 1998-1999 (n=1084, 0.9% of livebirths) than in (n=413, 0.78% of livebirths; p < O.OOl), including a higher proportion of VLBW infants of < 1000g birth weight (38% v 32% respectively; p < O.OS). Survival to discharge home increased from 81.8% in 1986 to 90.3% in 1998-1999 (p < O.OOl). The 1998-1999 cohort had a higher proportion of infants born in a hos pita l with a level Ill NICU (87% v 72% in 1986; p < O. OOI ) and receiving antenatal corticosteroids (80% v % in 1986: p < O.OOJ). in 1998-1999, the incidence of several morbidities had decreased compared with , including oxygen dependency of 28 days (29% v 39%, respectively; p =O. OOl) and at 36 weeks postmenstrual age (16% v 23%; p=0.002), grade 1 intraventricular haemorrhage (IVH ) (8% v 24%; p < O.OOJ), grade 2/3 IVH (5% v 11%; p < O.OOl ), and stage 3/4 ROP for infants < lOOOg (6% v 13%: p < O.OOl) Conclusions: The outlook for VLBW infants in New Zealand has improved since 1986.


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