Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. 29-36 (doi:10.1542/peds.2006-1472)
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ARTICLE

No Improvement in Outcome of Nationwide Extremely Low Birth Weight Infant Populations Between 1996–1997 and 1999–2000

Viena Tommiska, MD, PhDa,b, Kirsti Heinonen, MD, PhDc, Liisa Lehtonen, MD, PhDd, Martin Renlund, MD, PhDb, Timo Saarela, MD, PhDe, Outi Tammela, MD, PhDf, Martti Virtanen, MD, PhDg and Vineta Fellman, MD, PhDb,h

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 1996–1997 and 1999–2000 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 1996–1997 and 1999–2000. 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 1996–1997 to 1999–2000 (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: GW—gestational week • IVH—intraventricular hemorrhage • ROP—retinopathy of prematurity • BPD—bronchopulmonary dysplasia • ELBW—extremely low birth weight • SGA—small for gestational age • RDS—respiratory distress syndrome • NEC—necrotizing entercolitis • CP—cerebral palsy • PDA—persistent ductus arteriosus

Accepted Sep 19, 2006.




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