TY - JOUR
T1 - Trends in mortality and neurological injuries in very preterm outborn and inborn survivors cared for in Australian and New Zealand
AU - Mendoza, Giannina Tinoco
AU - Hossain, Sadia
AU - Keir, Amy
AU - Stewart, Michael
AU - Carmo, Kathryn Browning
AU - Cooke, Lucy
AU - Davies, Jonathan
AU - Hegarty, Joanne
AU - Sinclair, Ruth
AU - Battin, Malcolm
AU - Schindler, Tim
AU - Bolisetty, Srinivas
AU - Lui, Kei
PY - 2023
Y1 - 2023
N2 - Background: Very preterm infants (VPT), born outside (outborn) tertiary centres with on-site neonatal intensive care units (NICUs), are known to have higher rates of mortality and neurodevelopmental impairment than those inborn. This group sought to examine whether contemporary clinical practice and established coordinated regional retrieval services, has improved the outcomes for high-risk outborn infants over the preceding 25 years (1995 - 2019). Methods: A retrospective cohort study of the ANZNN NICU population database, for infants born at 22-31weeks gestational age (GA) and admitted to ANZ tertiary NICUs. Outborn and inborn infants were compared for trends in mortality at discharge and survival with serious neurological injury (SNI; presence of intraventricular haemorrhage grade 3/4 or periventricular leukomalacia) for infants born at 22-25 weeks, 26-27 weeks and 28-31 weeks GA, across five epochs (1995-1999, 2000- 2004, 2005-2009, 2010-2014, and 2015-2019). Results: 9370 (12%) of 78,517 VPT infants, were outborn. The outborn mortality was higher than for inborns (10% vs 7%, p<0.001); the VPT mortality rate gap narrowed over time from Epoch 1 to Epoch 5 (Epoch-1: 14.1% outborn v 9.8% inborn, p<0.001; Epoch-5: 7.4% v 5.9% respectively, p<0.01). While inborn mortality improved, the Difference-in-difference (DID) analysis showed overall outborn mortality improvement surpass that of inborns (estimate 2.8%, SE 1.0%, p=0.005). Reduction of mortality and SNI rate among survivors of the three gestational age groups varied for both outborn and inborn infants (Figure 1). Improvements, including fewer SNI outborn survivors, were seen in the higher gestation subgroups. Least favourable outcomes were seen in 22-25 weeks GA outborn infants, having highest mortality rate compared to their inborn counterparts, as well as an increase in SNI survivors. Conclusion: Survival to discharge increased and SNI among survivors decreased among VPT NICU infants in Australia and New Zealand from 1995 to 2019. Despite improving performance over and above the inborn gains, outborn VPT infants continue to have higher mortality and SNI among survivors than the inborns. Notwithstanding the evolution of regionalised neonatal retrieval services, it remains critical to support optimal maternal transport of pregnancies especially those born at <26 weeks GA to prevent death and neurodevelopmental disability in survivors.
AB - Background: Very preterm infants (VPT), born outside (outborn) tertiary centres with on-site neonatal intensive care units (NICUs), are known to have higher rates of mortality and neurodevelopmental impairment than those inborn. This group sought to examine whether contemporary clinical practice and established coordinated regional retrieval services, has improved the outcomes for high-risk outborn infants over the preceding 25 years (1995 - 2019). Methods: A retrospective cohort study of the ANZNN NICU population database, for infants born at 22-31weeks gestational age (GA) and admitted to ANZ tertiary NICUs. Outborn and inborn infants were compared for trends in mortality at discharge and survival with serious neurological injury (SNI; presence of intraventricular haemorrhage grade 3/4 or periventricular leukomalacia) for infants born at 22-25 weeks, 26-27 weeks and 28-31 weeks GA, across five epochs (1995-1999, 2000- 2004, 2005-2009, 2010-2014, and 2015-2019). Results: 9370 (12%) of 78,517 VPT infants, were outborn. The outborn mortality was higher than for inborns (10% vs 7%, p<0.001); the VPT mortality rate gap narrowed over time from Epoch 1 to Epoch 5 (Epoch-1: 14.1% outborn v 9.8% inborn, p<0.001; Epoch-5: 7.4% v 5.9% respectively, p<0.01). While inborn mortality improved, the Difference-in-difference (DID) analysis showed overall outborn mortality improvement surpass that of inborns (estimate 2.8%, SE 1.0%, p=0.005). Reduction of mortality and SNI rate among survivors of the three gestational age groups varied for both outborn and inborn infants (Figure 1). Improvements, including fewer SNI outborn survivors, were seen in the higher gestation subgroups. Least favourable outcomes were seen in 22-25 weeks GA outborn infants, having highest mortality rate compared to their inborn counterparts, as well as an increase in SNI survivors. Conclusion: Survival to discharge increased and SNI among survivors decreased among VPT NICU infants in Australia and New Zealand from 1995 to 2019. Despite improving performance over and above the inborn gains, outborn VPT infants continue to have higher mortality and SNI among survivors than the inborns. Notwithstanding the evolution of regionalised neonatal retrieval services, it remains critical to support optimal maternal transport of pregnancies especially those born at <26 weeks GA to prevent death and neurodevelopmental disability in survivors.
UR - https://hdl.handle.net/1959.7/uws:72780
U2 - 10.1111/jpc.16476
DO - 10.1111/jpc.16476
M3 - Article
SN - 1440-1754
VL - 59
SP - 58
EP - 59
JO - Journal of Paediatrics and Child Health
JF - Journal of Paediatrics and Child Health
IS - 52\, Suppl.
ER -