Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1374 (doi:10.1542/peds.2004-1296)

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Effectiveness of Neonatal Intensive Care for Extremely Low Birth Weight Infants

Howard W. Kilbride, MD
Section of Neonatal Medicine
Department of Pediatrics
Children's Mercy Hospitals and Clinics
Kansas City, MO 64108

To the Editor.

I commend Doyle et al^1,2 for the thorough longitudinal follow-up of their extremely low birth weight infants over 2 decades, which demonstrated greater overall and quality-adjusted survival for the most recently born cohorts. However, I think the authors overinterpreted the outcome data in concluding that these data demonstrate effectiveness and efficiency of neonatal intensive care. The study actually provides little information regarding neonatal intensive care management over the 2 decades and no data specifically relating neonatal management to the improved survival. The provision of neonatal intensive care over these decades has undoubtedly contributed to improved survival, but the influence of neonatal care should not be separated from obstetrical management as has been done in the Doyle et al study.

Specific obstetrical interventions including antenatal corticosteroid use,³ more liberal cesarean section delivery,⁴ and increased prenatal care⁵ have proven or suggested benefit for survival and decreased morbidity for low birth weight infants. It is likely that over the study period, obstetrical providers increasingly used these and other interventions for pregnancies at marginal gestations. Previous studies have suggested that a change in perception by obstetrical providers, without new technical interventions, may significantly benefit neonatal survival.^6,7

It is reassuring that in this geographically defined population, greater survival for extremely low birth weight infants was associated with increased quality-adjusted survival, which has certainly not been universally reported.^8,9 However, before concluding that this outcome has resulted from effective and efficient neonatal care, prenatal (and perhaps postneonatal) influences and associated costs must be considered in the analysis.

REFERENCES

1. Doyle LW; Victorian Infant Collaborative Study Group. Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: I. Effectiveness. Pediatrics. 2004;113 :505 –509[Abstract/Free Full Text]
2. Doyle LW; Victorian Infant Collaborative Study Group. Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency. Pediatrics. 2004;113 :510 –514[Abstract/Free Full Text]
3. Committee on Obstetric Practice. ACOG committee opinion: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2002;99 :871 –873[CrossRef][Web of Science][Medline]
4. Malloy MH, Rhoads GG, Schramm W, Land G. Increasing cesarean section rates in very low-birth weight infants. Effect on outcome. JAMA. 1989;262 :1475 –1478[Abstract/Free Full Text]
5. Herbst MA, Mercer BM, Beazley D, Meyer N, Carr T. Relationship of prenatal care and perinatal morbidity in low-birth-weight infants. Am J Obstet Gynecol. 2003;189 :930 –933[CrossRef][Web of Science][Medline]
6. Goldenberg RL, Nelson KG, Dyer RL, Wayne J. The variability of viability: the effect of physicians' perceptions on viability on survival of very low-birth weight infants. Am J Obstet Gynecol. 1982;143 :678 –684[Web of Science][Medline]
7. Martinez AM, Weiss E, Partridge JC, Freeman H, Kilpatrick S. Management of extremely low birth weight infants: perceptions of viability and parental counseling practices. Obstet Gynecol. 1998;92 :520 –524[CrossRef][Web of Science][Medline]
8. Hack M, Friedman H, Fanaroff AA. Outcomes of extremely low birth weight infants. Pediatrics. 1996;98 :931 –937[Abstract/Free Full Text]
9. Hoekstra RE, Ferrara TB, Couser RJ, Payne NR, Connett JE. Survival and long-term neurodevelopmental outcome of extremely premature infants born at 23–26 weeks' gestational age at a tertiary center. Pediatrics. 2004;113(1) . Available at: www.pediatrics.org/cgi/content/full/113/1/e1

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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Effectiveness of Neonatal Intensive Care for Extremely Low Birth Weight Infants: In Reply

Lex W. Doyle
Pediatrics 2004 114: 1374-1375. [Extract] [Full Text]  

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in Pediatrics Similar articles in this journal Similar articles in Web of Science 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 CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kilbride, H. W. Search for Related Content PubMed PubMed Citation Articles by Kilbride, H. W. Related Collections Premature & Newborn Social Bookmarking                         What's this?