The next challenge for newborn intensive care in Alaska: improving the survival of the larger neonate.

Using information from our database, a review of mortality for the Newborn Intensive Care Unit at Providence Alaska Medical Center was conducted for 1987-1996. There has been a significant decline in mortality over the last decade (p = 0.003). An analysis of mortality by birthweight and gestational age groups demonstrated a decline in mortality (p = 0.005) for infants with birthweight < 2 kg and infants < or = 34 weeks gestation, but no change for infants > or = 2 kg and > or = 35 weeks gestation. As a result, larger and more mature babies now account for an increasing proportion of NICU deaths. For 1995 and 1996 the major contributors to mortality for the smaller neonates were respiratory distress syndrome and congenital and nosocomial sepsis/pneumonia. The major contributors to mortality for larger neonates were persistent pulmonary hypertension of the newborn, congenital heart disease, congenital diaphragmatic hernia, and primary birth asphyxia. A majority of deaths in the larger neonates were due to non-lethal causes. We contend that improved survival in the larger neonate is an important and achievable goal. The introduction of ECMO (Extracorporeal Membrane Oxygenation) for the NICU and a focused review of the neonatal cardiac program offers the best possible potential for achieving this goal.