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1. The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities

Author

Shah, PS, Lui, K, Reichman, B, Norman, M, Kusuda, S, Lehtonen, L, Adams, M, Vento, M, Darlow, BA, Modi, N, Rusconi, F, Hakansson, S, San Feliciano, L, Helenius, KK, Bassler, D, Hirano, S, Lee, SK, Marshall, P, Schmidt, P, Dhawan, A, Craven, P, De Waal, K, Simmer, K, Gill, A, Pillow, J, Stack, J, Birch, P, Cooke, L, Casalaz, D, Holberton, J, Stewart, A, Downe, L, Stewart, M, Bajuk, B, Berry, A, Hunt, R, Kilburn, C, De Paoli, T, Bolisetty, S, Paradisis, M, Rieger, I, Koorts, P, Kuschel, C, Numa, A, Carlisle, H, Badawi, N, Loughran-Fowlds, A, Koh, G, Davis, J, Luig, M, Andersen, C, Chambers, G, Austin, N, Lynn, A, Darlow, B, Edmonds, L, Mildenhall, L, Buksh, M, Battin, M, Van den Boom, J, Bourchier, D, Richardson, V, Dineen, F, Rajadurai, VS, Fung, G, Harrison, A, Synnes, A, Ting, J, Cieslak, Z, Sherlock, R, Yee, W, Aziz, K, Toye, J, Fajardo, C, Kalapesi, Z, Sankaran, K, Daspal, S, Seshia, M, Alvaro, R, Mukerji, A, Da Silva, O, Nwaesei, C, Lee, K-S, Dunn, M, Lemyre, B, Dow, K, Pelausa, E, Barrington, K, Drolet, C, Piedboeuf, B, Claveau, M, Beltempo, M, Bertelle, V, Masse, E, Canning, R, Mabry, H, Ojah, C, Monterrosa, L, Deshpandey, A, Afifi, J, Kajetanowicz, A, Andersson, S, Tammela, O, Sankilampi, U, Saarela, T, Prazad, P, Noguchi, A, McWan, K, Button, B, Stratton, W, Hamvus, A, Raghaven, A, Derrick, M, Hadley, R, Covert, R, Lablanc, O, Weiss, M, Bell, A, Shareef, M, Silvestri, J, Heymann, E, Zangen, S, Smolkin, T, Mimouni, F, Bader, D, Rothschild, A, Strauss, Z, Felszer, C, Oman, H, Toy-Friedman, SE, Bar-Oz, B, Feldman, M, Saad, N, Flidel-Rimon, O, Weisbrod, M, Lubin, D, Litmanovitz, I, Kngelman, A, Shinwell, E, Klinger, G, Nijim, Y, Bin-Nun, A, Golan, A, Mandel, D, Fleisher-Sheffer, V, Kohelet, D, Bakhrakh, L, Hattori, S, Shirai, M, Ishioka, T, Mori, T, Amiznka, T, Huchimukai, T, Yoshida, H, Sasaki, A, Shimizu, J, Nakamura, T, Maruyama, M, Matsumoto, H, Hosokawa, S, Taki, A, Nakagawa, M, Ko, K, Uozumi, A, Nakata, S, Shimazaki, A, Yoda, T, Numata, O, Imamura, H, Kobayashi, A, Tokuriki, S, Uchida, Y, Arai, T, Ito, M, Ieda, K, Ono, T, Hayashi, M, Maki, K, Yamakawa, M, Kawai, M, Fujii, N, Shiomi, K, Nozaki, K, Wada, H, Kim, T, Tokunaga, Y, Takatera, A, Oshima, T, Sumida, H, Michinomae, Y, Knsumoto, Y, Yoshimoto, S, Morisawa, T, Ohashi, T, Takahashi, Y, Sugimoto, M, Ono, N, Miyagawa, S, Saijo, T, Yamagami, T, Koyano, K, Kobayashi, S, Kanda, T, Sakemi, Y, Aoki, M, Iida, K, Goshi, M, Maruyama, Y, Avila-Alvarez, A, Luis Fernandez-Trisac, J, Couce Pico, ML, Fernandez Seara, MJ, Martinez Gutierrez, A, Vizcaino, C, Salvador Iglesias, M, Sanchez Zaplana, H, Fernandez Colomer, B, Garcia Lopez, JE, Garcia Mozo, R, Gonzalez Martinez, MT, Muro Sebastian, MD, Balart Carbonell, M, Badia Bamnsell, J, Domingo Puiggros, M, Figueras Aloy, J, Botet Mussons, F, Anquela Sanz, I, Ginovart Galiana, G, Coroleu, W, Iriondo, M, Vilella, LC, Porta, R, Demestre, X, Martinez Nadal, S, De Frutos Martinez, C, Lopez Cuesta, MJ, Esquivel Mora, D, Ortiz Tardio, J, Benavente, I, Alonso, A, Aguilera Olmos, R, Garcia Cabezas, MA, Martinez Jimenez, MD, Jaraba Caballero, MF, Ordofiez Diaz, MD, Fagundo, AT, Canals, LM, Garcia-Munoz Rodrigo, F, Urquia Marti, L, Moreno Galdo, MF, Hurtado Suazo, JA, Narbona Lopez, E, Uberos Fernandez, J, Cortajarena Altana, MA, Mora Navarro, D, Teresa Dominguez, M, Ruiz del Prado, MY, Esteban Diez, I, Palau Benavides, MT, Lapena, S, Prada, T, Soler Mir, E, Corredera Sanchez, A, Criado Vega, E, Del Prado, N, Fernandez, C, Cabanillas Vilaplana, L, Cuadrado Perez, I, Lopez Gomez, L, Domingo Comeche, L, Llana Martin, I, Gonzalez Armengod, C, Munoz Labian, C, Santos Munoz, MJ, Blanco Bravo, D, Perez, V, Elorza Fernandez, MD, Diaz Gonzalez, C, Ares Segura, S, Lopez Azorin, M, Belen Jimenez, A, Sanchez-Tamayo, T, Tapia Moreno, E, Gonzalez, M, Sanchez Martinez, JE, Lloreda Garcia, JM, Goni Orayen, C, Vilas Gonzalez, J, Suarez Albo, M, Gonzalez Colmenero, E, Gutierrez Gonzalez, EP, Vacas del Arco, B, Marquez Fernandez, J, Acosta Gordillo, L, Granero Asensio, M, Macias Diaz, C, Albujar, M, Fuster Jorge, P, Romero, S, Rivero Falero, M, Escobar Izquierdo, AB, Estan Capell, J, Izquierdo Macian, MI, Montejo Vicente, MM, Izquierdo Caballero, R, Mercedes Martinez, M, Euba, A, Rodriguez Serna, A, De Heredia Goya, JML, Perez Legorburu, A, Gutierrez Amoros, A, Marugan Isabel, VM, Hernandez Gonzalez, N, Rite Gracia, S, Ventura Faci, MP, Samper Villagrasa, MP, Kofron, J, Brodd, KS, Odlind, A, Alberg, L, Arwehed, S, Hafstrom, O, Kasemo, A, Nederman, K, Ahman, L, Ingemarsson, F, Petersson, H, Thum, P, Albinsson, E, Selander, B, Abrahamsson, T, Heimdahl, I, Sveinsdottir, K, Wejryd, E, Hedlund, A, Soderberg, MK, Hallberg, B, Brune, T, Backstrom, J, Robinson, J, Farooqi, A, Normann, E, Fredriksson, M, Palm, A, Rosenqvist, U, Hagman, C, Ohlin, A, Floral, R, Smedsaas-Lofvenberg, A, Meyer, P, Anderegg, C, Schulzke, S, Nelle, M, Wagner, B, Riedel, T, Kaczala, G, Walde, B, Pfister, RE, Tolsa, J-F, Roth, M, Stocker, M, Laubscher, B, Malzacher, A, Micallef, JP, Hegi, L, Arlettaz, R, Bernet, V, Dani, C, Fiorini, P, Boldrini, A, Tomasini, B, Mittal, A, Kefas, J, Kamalanathan, A, Jayachandran, Yoxall, B, McBride, T, Webb, D, Garr, R, Hassan, A, Ambadkar, P, Dyke, M, McDevitt, K, Rewitzky, G, D'Amore, A, Panasa, N, Settle, P, Maddock, N, Edi-Osagie, N, Zipitis, C, Heal, C, Birch, J, Hasib, A, Soe, A, Kumar, N, Kisat, H, Vasu, V, Lama, M, Gupta, R, Rawlingson, C, Wickham, T, Theron, M, Kendall, G, Gupta, A, Aladangady, N, Ali, I, Alsford, L, Lopez, W, Murthy, V, Sullivan, C, Thomas, M, Bate, T, Godambe, S, Watts, T, Kuna, J, Chang, J, Pai, V, Huddy, C, Yasin, S, Nicholl, R, Pandey, P, Kairamkonda, V, Muogbo, D, Harry, L, Simmons, P, Nycyk, J, Gallagher, A, Pillay, T, Deshpande, S, Mahadevan, Moore, A, Clark, S, Garbash, M, Lal, M, Abu-Harb, M, Allwood, A, Selter, M, Munyard, P, Bartle, D, Paul, S, Whincup, G, Mallik, A, Amess, P, Godden, C, Reynolds, P, Misra, I, De Halpert, P, Salgia, S, Sanghavi, R, Wigfield, R, Deketelaere, A, Khashu, M, Hall, M, Groves, C, Brown, N, Brennan, N, Vamvakiti, K, McIntyre, J, Pirie, S, Jones, S, Mannix, P, Cairns, P, Eaton, M, Schwarz, K, Gibson, D, Miall, L, Krishnamurthy, University of Zurich, Shah, Prakesh S, Canadian Institutes of Health Research (CIHR), and Neonid NPO

Subjects
medicine.medical_specialty, NEW-ZEALAND, Population, 610 Medicine & health, RETINOPATHY, Review Article, Audit, Pediatrics, outcomes research, MORBIDITY, Nursing, neonatal intensive care, Health care, medicine, LOW-BIRTH-WEIGHT, 2735 Pediatrics, Perinatology and Child Health, education, education.field_of_study, Science & Technology, EXTREMELY PRETERM INFANTS, business.industry, MORTALITY, Public health, Health services research, Preterm infants, Capacity building, BRONCHOPULMONARY DYSPLASIA, Benchmarking, 10027 Clinic for Neonatology, INTENSIVE-CARE UNITS, TRENDS, CANADA, Pediatrics, Perinatology and Child Health, Outcomes research, business, Life Sciences & Biomedicine
Abstract

Neonates born very preterm (before 32 weeks’ gestational age), are a significant public health concern because of their high-risk of mortality and life-long disability. In addition, caring for very preterm neonates can be expensive, both during their initial hospitalization and their long-term cost of permanent impairments. To address these issues, national and regional neonatal networks around the world collect and analyse data from their constituents to identify trends in outcomes, and conduct benchmarking, audit and research. Improving neonatal outcomes and reducing health care costs is a global problem that can be addressed using collaborative approaches to assess practice variation between countries, conduct research and implement evidence-based practices. The International Network for Evaluating Outcomes (iNeo) of neonates was established in 2013 with the goal of improving outcomes for very preterm neonates through international collaboration and comparisons. To date, 10 national or regional population-based neonatal networks/datasets participate in iNeo collaboration. The initiative now includes data on >200,000 very preterm neonates and has conducted important epidemiological studies evaluating outcomes, variations and trends. The collaboration has also surveyed >320 neonatal units worldwide to learn about variations in practices, healthcare service delivery, and physical, environmental and manpower related factors and support services for parents. The iNeo collaboration serves as a strong international platform for Neonatal-Perinatal health services research that facilitates international data sharing, capacity building, and global efforts to improve very preterm neonate care.

Published
2019

2. Klinische Evaluation eines Überdruckventils für Kindertuben mit Cuff.

Author

Fertl, S., Bernet, V., Schmitz, A., Woitzek, K., and Weiss, M.

Subjects
*TRACHEA intubation, *CHILDREN'S health, *PEDIATRICS, *ANESTHESIA, *PILOT balloons
Abstract

The safe use of cuffed tracheal tubes for children necessitates a cuff pressure limitation at 20–25 cmH2O. The aim of the study was to evaluate the reliability and benefit of a new cuff pressure release valve (opening pressure 20 cmH2O) for children intubated with a cuffed tracheal tube. In a prospective, observational trial cuff pressure was recorded in paediatric and adolescent patients intubated with a cuffed tracheal tube during sevoflurane/nitrous oxide anaesthesia. The cuff pressure release valve was interposed between the cuff manometer and the pilot balloon. In 25 patients measurements were started at the initial opening pressure (group A) and in a further 25 patients measurements were started at the minimal sealing cuff pressure (group B). A total of 50 patients, aged from 0.4 to 17.8 years (median 7.4 years) were enrolled in the study. The opening pressure measured (group A) was 19.7±0.8 cmH2O and the cuff sealing pressure (group B) was 11.7±2.9 cmH2O (range 6–16 cmH2O). Mean cuff pressure values in group A were 20.4±1.6 cmH2O and 16.5±3.3 cmH2O in group B. In one patient (group A) the cuff pressure exceeded 25 cmH2O and was manually decreased to 20 cmH2O. In total, 24 filling procedures (group A 14; group B 10) were required during 103.1 h of investigation because of cuff pressure drop and audible air leakage, mainly caused by cuff pressure increases and consequent releases during patient positioning. Our data demonstrate that the tested cuff pressure release valve was useful and reliable to limit cuff pressure in tracheal intubated children and adolescents within an acceptable pressure range. [ABSTRACT FROM AUTHOR]

Published
2009
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3. Outer diameter and shape of paediatric tracheal tube cuffs at higher inflation pressures.

Author

Bernet, V., Dullenkopf, A., Maino, P., and Weiss, M.

Subjects
*CRITICAL care medicine, *ANESTHESIA, *PEDIATRICS, *ANESTHETICS, *AIRWAY (Anatomy), *RESPIRATION, *PEDIATRIC surgery, *ANESTHESIOLOGY
Abstract

Cuffed tracheal tubes are becoming increasingly popular in paediatric anaesthesia and intensive care medicine. To avoid cuff related complications and airway morbidity, a thorough understanding of cuff volume/pressure behaviour and management is required. In this study, the outer cuff diameter and form stability of the cuff at high cuff pressure were assessed in a series of different paediatric cuffed tracheal tubes with internal diameter of between 3.0 and 5.0 mm. The main findings were that small amounts of inflated air led to a rapid increase in cuff pressure and volume and that the outer cuff diameters increased to 2–2.5 times the age-corresponding internal tracheal diameter following inadvertent syringe inflation. Careful cuff inflation under cuff pressure monitoring and/or automatic cuff pressure release is recommended in paediatric tracheal tube cuffs to prevent airway damage caused by manual inflation, pilot balloon compression and nitrous oxide diffusion. [ABSTRACT FROM AUTHOR]

Published
2005
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4. Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study

Author

Adams, Mark, Berger, Thomas M, Borradori Tolsa, Cristina, Bickle-Graz, Myriam, Grunt, Sebastian, Gerull, Roland, Bassler, Dirk, Natalucci, Giancarlo, Swiss Neonatal Network & Follow-Up Group, Pfister, Riccardo, Hüppi, Petra Susan, Swiss Neonatal Network & Follow-Up Group, Anderegg, M.C., Mori, A.C., Kaeppeli, D., Schulzke, S., Weber, P., Ramelli, G.P., Simonetti, B.G., Nelle, M., Wagner, B., Steinlin, M., Grunt, S., Gebauer, M., Hassink, R., Bär, W., Keller, E., Killer, C., Fuhrer, K., Pfister, R.E., Hüppi, P.S., Borradori-Tolsa, C., Tolsa, J.F., Roth-Kleiner, M., Bickle-Graz, M., Berger, T.M., Schmitt-Mechelke, T., Bauder, F., Pezzoli, V., Erkert, B., Mueller, A., Ecoffey, M., Malzacher, A., Micallef, J.P., Lang-Dullenkopf, A., Hegi, L., Rhein, M.V., Bassler, D., Arlettaz, R., Bernet, V., Latal, B., Natalucci, G., and Moenkhoff, M.

Subjects
Male, fetal medicine, medicine.medical_specialty, Pediatrics, Developmental Disabilities, Gestational Age, 610 Medicine & health, Lower risk, neonatology, quality in health care, Child, Preschool, Developmental Disabilities/epidemiology, Female, Humans, Infant, Infant Mortality, Infant, Extremely Premature, Infant, Newborn, Intensive Care Units, Neonatal/standards, Length of Stay/statistics & numerical data, Perinatal Care/standards, Retrospective Studies, Switzerland/epidemiology, 03 medical and health sciences, Population based cohort, 0302 clinical medicine, Intensive Care Units, Neonatal, 030225 pediatrics, Intensive care, medicine, 030212 general & internal medicine, Neonatology, ddc:618, business.industry, Research, Extremely preterm, Paediatrics, Retrospective cohort study, General Medicine, Fetal medicine, Length of Stay, 3. Good health, Perinatal Care, Institutional repository, Cohort, Quality in health care, business, Switzerland
Abstract

ObjectivesTo investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22–25 and cohort B born at 26–27 gestational weeks, respectively.DesignGeographically defined, retrospective cohort study.SettingAll nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland.PatientsAll live-born infants in Switzerland in 2006–2013 below 28 gestational weeks, excluding infants with major congenital malformation.Outcome measuresOutcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI).ResultsCohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A.ConclusionsCentres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.

Published
2019
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5. When parents face the death of their child: a nationwide cross-sectional survey of parental perspectives on their child's end-of life care

Author

Von Der Weid, Nicolas, Bergstraesser, Eva, Fahrni-Nater, Patricia, Engberg, Sandra, Zimmermann, Karin, Steinlin, Maja, Wagner, Bendicht Peter, Grandjean, Chantal, Leibundgut, Kurt, Paediatric End-Of-LIfe CAre Needs, PELICAN, Nelle, Mathias, Cignacco, Eva, Aebi, Christoph, Pfammatter, Jean-Pierre, Marfurt-Russenberger, Katrin, Ramelet, Anne-Sylvie, PELICAN Consortium, Ansari, M., Aebi, C., Baer, R., Popovic, MB., Bernet, V., Brazzola, P., Bucher, HU., Buder, R., Cagnazzo, S., Dinten, B., Dorsaz, A., Elmer, F., Enriquez, R., Finkbeiner, G., Frey, B., Frey, U., Greiner, J., Hassink, RI., Keller, S., Kretschmar, O., Kröll, J., Laubscher, B., Leibundgut, K., Malär, R., Meyer, A., Stuessi, C., Nelle, M., Neuhaus, T., Niggli, F., Perrenoud, G., Pfammatter, JP., Plecko, B., Rupf, D., Sennhauser, F., Stade, C., Steinlin, M., Stoffel, L., Thomas, K., Vonarburg, C., von Vigier, R., Wagner, B., Wieland, J., Wernz, B., University of Zurich, and Cignacco, Eva

Subjects
Male, Parents, Palliative care, Cross-sectional study, 2700 General Medicine, Pediatrics, Pediatrics/standards, Terminal Care/standards, 0302 clinical medicine, Questionnaire survey, Resuscitation Orders/psychology, Surveys and Questionnaires, Health care, 610 Medicine & health, Resuscitation Orders, Medicine(all), education.field_of_study, Terminal Care, ddc:618, Questionnaire, General Medicine, humanities, Death, 030220 oncology & carcinogenesis, Female, Erratum, End-of-life care, Switzerland, Parents/psychology, Research Article, Attitude of Health Personnel, Attitude to Death, Cross-Sectional Studies, Decision Making, Humans, Infant, Newborn, Perception, medicine.medical_specialty, Population, Parental perspectives, MEDLINE, 03 medical and health sciences, 030225 pediatrics, medicine, education, Estimation, business.industry, Paediatrics, 10027 Clinic for Neonatology, 10036 Medical Clinic, Family medicine, business, End-of-life
Abstract

Background Parents facing the death of their child have a strong need for compassionate professional support. Care services should be based on empirical evidence, be sensitive to the needs of the families concerned, take into account the heterogeneity within the medical field of paediatrics, and fit into the local health care system. We need to better understand the perspectives of parents facing the death of their child in order to guide further development and evaluation of specialised paediatric palliative and end-of-life (EOL) care services. Methods Questionnaire survey to assess the EOL care perspectives of a Swiss population-based sample of bereaved parents who had lost a child due to a cardiac, neurological or oncological condition, or during the neonatal period in the years 2011 or 2012. The parental perspective was assessed with a newly developed and tested instrument that was structured according to six evidence-based quality domains. Responses regarding parental experiences and perceived satisfaction are described. Differences between the four diagnostic groups are analysed using a generalized estimation equation to account for the dyadic data structure. Results Of 307 eligible families, 267 could be contacted and 135 (51 %) consented to participate in this questionnaire survey. Our findings show positive parental experiences of their child’s EOL care and high perceived satisfaction with the care their child received. Parents of a child with cancer rated their experiences highest in most of the six quality domains and reported the highest satisfaction with care. The lowest scores were mainly reported by parents from the neurology group, with the exception of the shared decision making domain, where parents of neonates reported significantly less positive experiences. Conclusions Although positive in general, our study results suggest some areas for improvement. The integration of specialised paediatric palliative care has the potential to minimise lost opportunities to support and assist parents. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0098-3) contains supplementary material, which is available to authorized users.

Published
2015
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6. Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008

Author

Mark Raymond Adams, Elena Proietti, Maude Aebischer, Hans Ulrich Bucher, Cristina Borradori-Tolsa, Sebastian Grunt, Beatrice Latal, Giancarlo Natalucci, Myriam Bickle-Graz, Luregn J. Schlapbach, Swiss Neonatal Network & Follow-up Group, Zeilinger, G., Capone, A., Steiner, F., Schulzke, S., Weber, P., Ramelli, GP., Nelle, M., Steinlin, M., Grunt, S., Hassink, R., Bär, W., Keller, E., Killer, Ch., Fuhrer, K., Tolsa, JF., Bickle-Graz, M., Pfister, RE., Huppi, PS., Borradori-Tolsa, C., Berger, TM., Schmitt-Mechelke, T., Pezzoli, V., Ecoffey, M., Mueller, A., Malzacher, A., Micallef, JP., Schaefer, Ch., von Rhein, M., Arlettaz Mieth, R., Bernet, V., Latal, B., Natalucci, G., University of Zurich, and Natalucci, Giancarlo

Subjects
Male, Pediatrics, Multivariate analysis, Developmental Disabilities, Infant, Premature, Diseases, Severity of Illness Index, Nervous System Diseases/epidemiology/etiology/mortality, 0302 clinical medicine, Switzerland/epidemiology, Risk Factors, 030212 general & internal medicine, Prospective Studies, Registries, 610 Medicine & health, Prospective cohort study, Outcome, education.field_of_study, ddc:618, Incidence (epidemiology), Follow up studies, lcsh:RJ1-570, 3. Good health, Child, Preschool, Infant, Extremely Premature, Developmental Disabilities/epidemiology/etiology/mortality, Female, Switzerland, Research Article, medicine.medical_specialty, Population, Development, National cohort, 03 medical and health sciences, Preterm, 030225 pediatrics, Severity of illness, medicine, Humans, 2735 Pediatrics, Perinatology and Child Health, Pediatrics, Perinatology, and Child Health, Mortality, education, Infant, Premature, Diseases/epidemiology/etiology/mortality, Psychological Tests, Disability, business.industry, Extremely preterm, Infant, Newborn, lcsh:Pediatrics, 10027 Clinic for Neonatology, Logistic Models, 10036 Medical Clinic, Pediatrics, Perinatology and Child Health, Multivariate Analysis, Nervous System Diseases, business, Follow-Up Studies
Abstract

BackgroundWhile survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling.MethodsProspective longitudinal multicentre cohort study of preterm infants born in Switzerland between 240/7and 276/7weeks gestational age during 2000–2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System.ResultsOf 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p 0/7weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p ConclusionsIn this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

Published
2012
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