search text   Advanced Search

This Article Full Text Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via ISI Web of Science (27) Citing Articles via Google Scholar Google Scholar Articles by Stoelhorst, G. M. S. J. Search for Related Content PubMed PubMed Citation Articles by Stoelhorst, G. M. S. J. Related Collections Premature & Newborn

Changes in Neonatology: Comparison of Two Cohorts of Very Preterm Infants (Gestational Age <32 Weeks): The Project on Preterm and Small for Gestational Age Infants 1983 and The Leiden Follow-Up Project on Prematurity 1996-1997

Gerlinde M. S. J. Stoelhorst, MD, PhD^*, Monique Rijken, MD^*, Shirley E. Martens, MD^*, Ronald Brand, PhD, A. Lya den Ouden, MD, PhD, Jan-Maarten Wit, MD, PhD^*, Sylvia Veen, MD, PhD^* on behalf of the Leiden Follow-up Project on Prematurity

^* Departments of Pediatrics
Medical Statistics, Leiden University Medical Center, Leiden, Netherlands
Ministry of Health and Science, The Hague, Netherlands

Objective. To determine changes in peri- and neonatal care concerning neonatal mortality and morbidity by comparing 2 cohorts of very prematurely born infants (gestational age [GA] <32 weeks), 1 from the 1980s and 1 from the 1990s.

Methods. The Leiden Follow-Up Project on Prematurity (LFUPP-1996/97), a regional, prospective study, includes all infants who were born alive after a GA <32 weeks in 1996 and 1997 in the Dutch health regions Leiden, The Hague, and Delft. The Project On Preterm and Small for Gestational Age Infants (POPS-1983), a national, prospective study from the presurfactant era, includes all liveborn infants <32 weeks' GA and/or <1500 g from 1983 (n = 1338). For comparison, infants from the POPS-1983 cohort with a GA <32 weeks from the same Dutch health regions were selected (n = 102).

Results. The absolute number of preterm births in the study region increased by 30%: 102 in 1983 to on average of 133 in 1996–1997. Centralization of perinatal care improved: the percentage of extrauterinely transported infants decreased from 61% in 1983 to 35% in 1996–1997. A total of 182 (73%) of the LFUPP-1996/97 infants were treated antenatally with glucocorticosteroids compared with 6 (6%) of the POPS-1983 infants. A total of 112 (42%) of the LFUPP-1996/97 infants received surfactant. In-hospital mortality decreased from 30% in the 1980s to 11% in the 1990s. Mortality of the extremely preterm infants (<27 weeks) decreased from 76% to 33%. The incidence of respiratory distress syndrome remained the same: 60% in both groups. Mortality from respiratory distress syndrome, however, decreased from 29% to 8%. The incidence of bronchopulmonary dysplasia increased from 6% to 19%. For the surviving infants, the average length of stay in the hospital and the mean number of NICU days stayed approximately the same (67 days total admission time and 44 NICU days in both groups); including the infants who died, the mean NICU admission time increased from 27 days in the 1980s to 41 days in the 1990s. Equal percentages of adverse outcome (dead or an abnormal general condition) at the moment of discharge from hospital were found (±40% in both groups).

Conclusions. An increase in the absolute number of very preterm births in this study region was found, leading to a greater burden on the regional NICUs. Improvements in peri- and neonatal care have led to an increased survival of especially extremely preterm infants. However, increased survival has resulted in more morbidity, mainly bronchopulmonary dysplasia, at the moment of discharge from the hospital.

Key Words: changes in peri- and neonatal care • time trend

Abbreviations: LFUPP, Leiden Follow-up Project on Prematurity • POPS, Project on Preterm and Small for Gestational Age Infants • GA, gestational age • SGA, small for gestational age • RDS, respiratory distress syndrome • BPD, bronchopulmonary dysplasia • PROM, prolonged rupture of membranes • IVF, in vitro fertilization • IVH, intraventricular hemorrhage • OR, odds ratio

This article has been cited by other articles:

				J. Zeitlin, E. S. Draper, L. Kollee, D. Milligan, K. Boerch, R. Agostino, L. Gortner, P. Van Reempts, J.-L. Chabernaud, J. Gadzinowski, et al. Differences in Rates and Short-term Outcome of Live Births Before 32 Weeks of Gestation in Europe in 2003: Results From the MOSAIC Cohort Pediatrics, April 1, 2008; 121(4): e936 - e944. [Abstract] [Full Text] [PDF]

				G. K. Swamy, T. Ostbye, and R. Skjaerven Association of Preterm Birth With Long-term Survival, Reproduction, and Next-Generation Preterm Birth JAMA, March 26, 2008; 299(12): 1429 - 1436. [Abstract] [Full Text] [PDF]

				C. M. Maguire, S. Veen, A. J. Sprij, S. Le Cessie, J. M. Wit, F. J. Walther, and on behalf of the Leiden Developmental Care Project Effects of Basic Developmental Care on Neonatal Morbidity, Neuromotor Development, and Growth at Term Age of Infants Who Were Born at <32 Weeks Pediatrics, February 1, 2008; 121(2): e239 - e245. [Abstract] [Full Text] [PDF]

				F. Pisani, C. Cerminara, C. Fusco, and L. Sisti Neonatal status epilepticus vs recurrent neonatal seizures: Clinical findings and outcome Neurology, December 4, 2007; 69(23): 2177 - 2185. [Abstract] [Full Text] [PDF]

				E. T. M. Hille, N. Weisglas-Kuperus, J. B. van Goudoever, G. W. Jacobusse, M. H. Ens-Dokkum, L. de Groot, J. M. Wit, W. B. Geven, J. H. Kok, M. J. K. de Kleine, et al. Functional Outcomes and Participation in Young Adulthood for Very Preterm and Very Low Birth Weight Infants: The Dutch Project on Preterm and Small for Gestational Age Infants at 19 Years of Age Pediatrics, September 1, 2007; 120(3): e587 - e595. [Abstract] [Full Text] [PDF]

				R. B. Russell, N. S. Green, C. A. Steiner, S. Meikle, J. L. Howse, K. Poschman, T. Dias, L. Potetz, M. J. Davidoff, K. Damus, et al. Cost of Hospitalization for Preterm and Low Birth Weight Infants in the United States Pediatrics, July 1, 2007; 120(1): e1 - e9. [Abstract] [Full Text] [PDF]

				P. Hovi, S. Andersson, J. G. Eriksson, A.-L. Jarvenpaa, S. Strang-Karlsson, O. Makitie, and E. Kajantie Glucose Regulation in Young Adults with Very Low Birth Weight N. Engl. J. Med., May 17, 2007; 356(20): 2053 - 2063. [Abstract] [Full Text] [PDF]

				T. M. O'Shea, S. Nageswaran, D. C. Hiatt, C. Legault, M. L. Moore, M. Naughton, D. J. Goldstein, and R. G. Dillard Follow-up Care for Infants With Chronic Lung Disease: A Randomized Comparison of Community- and Center-Based Models Pediatrics, April 1, 2007; 119(4): e947 - e957. [Abstract] [Full Text] [PDF]

				N Finer To intubate or not--that is the question: continuous positive airway pressure versus surfactant and extremely low birthweight infants. Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2006; 91(6): F392 - F394. [Full Text] [PDF]

				M. J.J. Finken, F. W. Dekker, F. de Zegher, J. M. Wit, and for the Dutch Project on Preterm and Small-for-Ges Long-term Height Gain of Prematurely Born Children With Neonatal Growth Restraint: Parallellism With the Growth Pattern of Short Children Born Small for Gestational Age Pediatrics, August 1, 2006; 118(2): 640 - 643. [Abstract] [Full Text] [PDF]

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2005 American Academy of Pediatrics. All rights reserved.