OBJECTIVE: To assess the impact of recent changes in neonatal intensive care on the mortality and morbidity of very-low-birth-weight neonates (< 1501 g). DESIGN: Prospective cohort study. SETTING: Six neonatal intensive care units in Wisconsin and Iowa. PARTICIPANTS: All very-low-birth-weight neonates who were admitted to the neonatal intensive care units the year before the availability of exogenous surfactant (n = 333), during the investigational new drug protocol for synthetic surfactant (Exosurf) (n = 347), and after the release of synthetic surfactant (n = 356) (designated as periods 1, 2, and 3, respectively). INTERVENTIONS: None. MAIN RESULTS: The percentage of neonates receiving exogenous surfactant in the three periods was 3%, 37%, and 56%, and the percentage receiving antenatal steroids was 12%, 17%, and 27% (P = .0001 for increase in both modalities). The percentage of neonates dying in the three periods was 23%, 14%, and 19% (P = .05 for downward trend). The percentage of neonates with intraventricular hemorrhage decreased in the subgroup weighing between 700 and 1350 g (35%, 28%, and 24%) (P = .04) and increased in the subgroup weighing below 700 g (8%, 41%, and 45%) (P = .03). The percentage of neonates with bronchopulmonary dysplasia increased from 21% to 36% between periods 1 and 2 (P = .003) and decreased to 27% (P = .04) in period 3. Antenatal steroid use was strongly associated with the decrease in intraventricular hemorrhage (odds ratio, 0.35) and mortality risk (odds ratio, 0.20). CONCLUSIONS: Several developments in care have contributed to changes in mortality risk, incidence of intraventricular hemorrhage, and the severity of respiratory disease in very-low-birth-weight infants.
OBJECTIVE: To assess the impact of recent changes in neonatal intensive care on the mortality and morbidity of very-low-birth-weight neonates (< 1501 g). DESIGN: Prospective cohort study. SETTING: Six neonatal intensive care units in Wisconsin and Iowa. PARTICIPANTS: All very-low-birth-weight neonates who were admitted to the neonatal intensive care units the year before the availability of exogenous surfactant (n = 333), during the investigational new drug protocol for synthetic surfactant (Exosurf) (n = 347), and after the release of synthetic surfactant (n = 356) (designated as periods 1, 2, and 3, respectively). INTERVENTIONS: None. MAIN RESULTS: The percentage of neonates receiving exogenous surfactant in the three periods was 3%, 37%, and 56%, and the percentage receiving antenatal steroids was 12%, 17%, and 27% (P = .0001 for increase in both modalities). The percentage of neonates dying in the three periods was 23%, 14%, and 19% (P = .05 for downward trend). The percentage of neonates with intraventricular hemorrhage decreased in the subgroup weighing between 700 and 1350 g (35%, 28%, and 24%) (P = .04) and increased in the subgroup weighing below 700 g (8%, 41%, and 45%) (P = .03). The percentage of neonates with bronchopulmonary dysplasia increased from 21% to 36% between periods 1 and 2 (P = .003) and decreased to 27% (P = .04) in period 3. Antenatal steroid use was strongly associated with the decrease in intraventricular hemorrhage (odds ratio, 0.35) and mortality risk (odds ratio, 0.20). CONCLUSIONS: Several developments in care have contributed to changes in mortality risk, incidence of intraventricular hemorrhage, and the severity of respiratory disease in very-low-birth-weight infants.
Authors: Kara N Goss; Arij G Beshish; Gregory P Barton; Kristin Haraldsdottir; Taylor S Levin; Laura H Tetri; Therese J Battiola; Ashley M Mulchrone; David F Pegelow; Mari Palta; Luke J Lamers; Andrew M Watson; Naomi C Chesler; Marlowe W Eldridge Journal: Am J Respir Crit Care Med Date: 2018-12-15 Impact factor: 21.405
Authors: Melissa L Bates; De-Ann M Pillers; Mari Palta; Emily T Farrell; Marlowe W Eldridge Journal: Respir Physiol Neurobiol Date: 2013-07-22 Impact factor: 1.931
Authors: Kristin Haraldsdottir; Andrew M Watson; Arij G Beshish; Dave F Pegelow; Mari Palta; Laura H Tetri; Melissa D Brix; Ryan M Centanni; Kara N Goss; Marlowe W Eldridge Journal: Eur J Appl Physiol Date: 2019-01-11 Impact factor: 3.078
Authors: Emily T Farrell; Melissa L Bates; David F Pegelow; Mari Palta; Jens C Eickhoff; Matthew J O'Brien; Marlowe W Eldridge Journal: Ann Am Thorac Soc Date: 2015-08
Authors: K Telford; L Waters; H Vyas; B N Manktelow; E S Draper; N Marlow Journal: Arch Dis Child Fetal Neonatal Ed Date: 2006-08-11 Impact factor: 5.747