ARTICLE |
a National Research and Development Centre for Welfare and Health, Helsinki, Finland
b Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
c Department of Pediatrics, University of Kuopio, Kuopio, Finland
d Department of Pediatrics, University of Turku, Turku, Finland
e Department of Pediatrics, University of Oulu, Oulu, Finland
f Department of Pediatrics, University of Tampere, Tampere, Finland
g Nordic Centre for Classifications in Health Care, Uppsala, Sweden
h Department of Pediatrics, University of Lund, Lund, Sweden
OBJECTIVE. Our goal was to investigate whether outcome in extremely low birth weight infants changes over time in Finland.
PATIENTS AND METHODS. All infants with a birth weight <1000 g born in Finland in 19961997 and 19992000 were included in the study. Perinatal and follow-up data were collected in a national extremely low birth weight infant research register. Data concerning cerebral palsy and visual impairment were obtained from hospitals, the national discharge, and visual impairment registers.
RESULTS. A total of 529 and 511 extremely low birth weight infants were born during 19961997 and 19992000. No changes were detected in prenatal, perinatal, neonatal, and postneonatal mortality rates between the periods. The survival rates including stillborn infants were 40% and 44%. The incidence of respiratory distress syndrome and septicemia increased from 19961997 to 19992000 (75% vs 83% and 23% vs 31%). The overall incidence of intraventricular hemorrhage increased (29% vs 37%), but the incidence of intraventricular hemorrhage grades 3 through 4 did not (16% vs 17%). The rates of oxygen dependency at the age corresponding with 36 gestational weeks, retinopathy of prematurity stages 3 to 5, cerebral palsy, and severe visual impairment did not change. Mortality remained higher in 1 university hospital area during both periods compared with the other 4 areas, but no regional differences in morbidity were detected during the later period.
CONCLUSIONS. No significant changes were detected in birth or mortality rate in extremely low birth weight infants born in Finland during the late 1990s, but some neonatal morbidities seemed to increase. Regional differences in mortality were detected in both cohorts. Repeated long-term follow-up studies on geographically defined very preterm infant cohorts are needed for establishing reliable outcome data of current perinatal care. Regional differences warrant thorough audits to assess causalities.
Key Words: low gestational age mortality neonatal morbidity cerebral palsy visual impairment
Abbreviations: GWgestational week IVHintraventricular hemorrhage ROPretinopathy of prematurity BPDbronchopulmonary dysplasia ELBWextremely low birth weight SGAsmall for gestational age RDSrespiratory distress syndrome NECnecrotizing entercolitis CPcerebral palsy PDApersistent ductus arteriosus
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