OBJECTIVE: The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia. METHODS: The intervention included additional, network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system, with preferential admission of retrieved infants (outborn infants) to perinatal centers instead of freestanding pediatric hospitals, from the middle of 1995. Population birth and NICU admission cohorts of infants of 23 to 28 weeks of gestation were studied. Outcomes of epoch 1 (1992 to the middle of 1995; 1778 births and 1100 NICU admissions) were compared with those of epoch 2 (1997-2002; 3099 births and 2100 NICU admissions), after an 18-month washout period. RESULTS: There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants. CONCLUSIONS: Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.
OBJECTIVE: The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia. METHODS: The intervention included additional, network-coordinated, perinatal telephone advice to optimize in utero transfers and centralization of the neonatal retrieval system, with preferential admission of retrieved infants (outborn infants) to perinatal centers instead of freestanding pediatric hospitals, from the middle of 1995. Population birth and NICU admission cohorts of infants of 23 to 28 weeks of gestation were studied. Outcomes of epoch 1 (1992 to the middle of 1995; 1778 births and 1100 NICU admissions) were compared with those of epoch 2 (1997-2002; 3099 births and 2100 NICU admissions), after an 18-month washout period. RESULTS: There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborninfants. CONCLUSIONS: Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.
Authors: Tomas Honzik; Marketa Tesarova; Martin Magner; Johannes Mayr; Pavel Jesina; Katerina Vesela; Laszlo Wenchich; Karol Szentivanyi; Hana Hansikova; Wolfgang Sperl; Jiri Zeman Journal: J Inherit Metab Dis Date: 2012-01-10 Impact factor: 4.982
Authors: Prakesh S Shah; Shoo K Lee; Kei Lui; Gunnar Sjörs; Rintaro Mori; Brian Reichman; Stellan Håkansson; Laura San Feliciano; Neena Modi; Mark Adams; Brian Darlow; Masanori Fujimura; Satoshi Kusuda; Ross Haslam; Lucia Mirea Journal: BMC Pediatr Date: 2014-04-23 Impact factor: 2.125
Authors: Joyce T Johnson; Lloyd Y Tani; Michael D Puchalski; Tyler R Bardsley; Janice L B Byrne; L LuAnn Minich; Nelangi M Pinto Journal: Pediatr Cardiol Date: 2014-06-04 Impact factor: 1.655
Authors: L E Kelly; P S Shah; S Håkansson; S Kusuda; M Adams; S K Lee; G Sjörs; M Vento; F Rusconi; L Lehtonen; B Reichman; B A Darlow; K Lui; L S Feliciano; L Gagliardi; D Bassler; N Modi Journal: J Perinatol Date: 2017-04-06 Impact factor: 2.521