Published online September 1, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1130-e1138 (doi:10.1542/peds.2005-2724)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters 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 PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kusuda, S. Search for Related Content PubMed PubMed Citation Articles by Kusuda, S. Related Collections Premature & Newborn Social Bookmarking                         What's this?

ARTICLE

Morbidity and Mortality of Infants With Very Low Birth Weight in Japan: Center Variation

Satoshi Kusuda, MD^a, Masanori Fujimura, MD^b, Izumi Sakuma, MD^a, Hirofumi Aotani, MD^c, Kazuhiko Kabe, MD^d, Yasufumi Itani, MD^e, Hiroyuki Ichiba, MD^f, Katsura Matsunami, MD^b, Hiroshi Nishida, MD^a for the Neonatal Research Network, Japan

^a Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
^b Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
^c Department of Pediatrics, Shiga Medical University, Shiga, Japan
^d Department of Neonatology, Aiiku Hospital, Aiiku, Japan
^e Department of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan
^f Department of Neonatology, Osaka City General Hospital, Osaka, Japan

OBJECTIVES. The objectives of this study were to describe the characteristics and morbidity of very low birth weight infants, to identify the medical intervention for these infants, and to evaluate the factors affecting the mortality of these infants among the participating hospitals.

METHODS. A large multicenter neonatal research network that included level III NICUs from throughout Japan was established. A standardized mortality rate was formulated by giving a ratio of the observed deaths and the predicted deaths based on a 100-g birth weight interval mortality. A regression model was used to predict the factors that affect neonatal mortality.

RESULTS. The network included 37 centers and 2145 infants weighing 1500 g, born or admitted to the centers in 2003. Gestational age and birth weight of studied infants were 28.6 ± 3.6 gestational weeks (mean ± SD) and 1025 ± 302 g, respectively. Overall, 11% of the infants died before being discharged from hospitals (range: 0%–21%). The standardized mortality rate varied among the facilities (range: 0%–30%). No association between the annual number of patients admitted and standardized mortality rate was found. Among all of the very low birth weight infants, 14% were outborn infants, 72% were delivered by cesarean sections, 27% had patent ductus arteriosus, 3% had gastrointestinal perforation, 8% had bacterial sepsis, and 13% had intraventricular hemorrhage. Medical interventions involved were: 41% antenatal corticosteroids, 54% surfactant therapy, 18% postnatal steroids for chronic lung disease, and 29% high-frequency oscillatory ventilation. We found variations in the medical interventions and the clinical outcomes among the centers.

CONCLUSIONS. The overall survival rate for very low birth weight infants among neonatal centers in Japan was 90%. However, differences in the morbidity and mortality were observed among these centers.

---

Key Words: neonate • very low birth weight • mortality • morbidity

Abbreviations: VLBW—very low birth weight • GA—gestational age • DM—diabetes mellitus • GDM—gestational diabetes mellitus • PROM—premature rupture of membranes • ANS—antenatal steroid • CLD—chronic lung disease • PNS—postnatal steroid • PDA—patent ductus arteriosus • PPHN—persistent pulmonary hypertension of the newborn • IVH—intraventricular hemorrhage • NEC—necrotizing enterocolitis • PVL—periventricular leukomalacia • ROP—retinopathy of prematurity • AOP—adrenal insufficiency of prematurity • SMR—standardized neonatal mortality rate • CI—confidence interval • NICHD—National Institute of Child Health and Human Development

---

Accepted May 23, 2006.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. Miwa, S. Kusuda, and K. Ikeda International Perspectives: Late-onset Circulatory Collapse in Very Low-birthweight Infants: A Japanese Perspective NeoReviews, August 1, 2009; 10(8): e381 - e386. [Abstract] [Full Text] [PDF]