Elsevier

Early Human Development

Volume 82, Issue 2, February 2006, Pages 117-124
Early Human Development

Data collection from very low birthweight infants in a geographical region: Methods, costs, and trends in mortality, admission rates, and resource utilisation over a five-year period

https://doi.org/10.1016/j.earlhumdev.2005.10.019Get rights and content

Abstract

Aims

1. To determine the survival and morbidity of infants at discharge with a birthweight of less than 1500 g in the geographically defined population of East Anglia. 2. To demonstrate a cost-effective method of regional data collection. 3. To determine whether there were any changes in the demand for neonatal care.

Study design and subjects

A prospective cohort analysis using a single database to collect data on 1244 very low birthweight infants from eight neonatal units in one Region from 1993 to 1997.

Results

Estimated ascertainment of VLBW infants to the study was 96%. Over the 5 years survival rates were stable (75–79%). 52% of deaths in infants admitted for neonatal care occurred on day 1, with just 15% of deaths occurring after 28 days of life. Mortality risk significantly decreased with increasing gestational age at birth. Compared to 22–25-week old infants, the mortality risk decreased by 65% for 26–27-week old infants (OR 0.35 95% CI (0.21, 0.59)) and by 92% for 32–39-week old infants (OR 0.08 95% CI (0.03, 0.21)) with intermediate odds ratios of 0.22 (0.12, 0.42) and 0.13 (0.06, 0.28) for the 28–29 and 30–39 weeks gestation, respectively. Higher birthweight, after adjusting for gestation also decreased the mortality risk (OR 0.78 per 100 g difference, 95% CI (0.71, 0.86)). No change was seen in the number of extremely preterm infants admitted for intensive care or resource utilisation, although a significant increase was seen in the number of infants dying in delivery rooms. There was a reduction in the reported incidence of pulmonary interstitial emphysema (10–4%) but no change in the number of ventilation days or the rate of chronic lung disease. The mean maternal age increased from 27.7 years to 28.9 years during the study. Maternal steroid administration increased (30% to 59%) and was associated with a decreased risk of mortality (OR 0.44, 95% CI: 0.31–0.62).

Conclusions

It is possible to collect useful data from the neonatal period at a reasonable cost from a geographically defined population. This information was used for informing clinicians, counselling parents and in the era of managed clinical networks will be useful in guiding the provision of effective health care resources.

Introduction

In 1993 following national calls in the UK for neonatal follow-up programmes, [1] the neonatal units within the East Anglian Region collaborated to collect population-based data. Many follow-up studies collect data on survivors from tertiary centres alone and are not therefore representative of a complete geographical population [2], [3], [4]. We wished to collect recent clinical data on outcomes in a regional VLBW population. This information was used to identify patterns and trends from a larger population than that collected by single unit and to provide information for counselling parents. We describe the methods used to collect and analyse the data and discuss problems encountered. Data on neurodevelopmental outcomes at two years will be described elsewhere.

Section snippets

Patients and methods

Each of the neonatal intensive care units in the East Anglian region participated. In 1993, one was located in a teaching hospital, three in large district general hospitals (> 3500 deliveries per year) and four in small district general hospitals (< 3500 deliveries per year). In total the units deal with approximately 25,000 births each year including around 250 VLBW babies per year. The National census of 2001, documented the population of the East Anglian region as approximately two and a half

Births

Over the five-year period 1 January 1993 through to 31 December 1997, OPCS recorded 1297 VLBW infants born in the East Anglian Region. Table 1 shows the number of VLBW babies who died during labour, those that died in delivery rooms without admission, and those admitted for intensive care each year (range 236–267). The proportion of babies born below 1500 g remained stable at around 1% of the total births, with a non-significant increase in 1996 and 1997. Estimated ascertainment of very low

Discussion

This study describes a standardised method of data collection to determine the mortality and morbidity of VLBW infants across a geographical region: East Anglia in the United Kingdom. These data were collated and published on a yearly basis, providing information to inform clinicians and the parents of VLBW infants. Local consultants provided follow up and examination of the entire cohort to the age of 2 years as this was an agreed standard of clinical care within the region for VLBW infants.

Implications

Useful data can be collected in a cost effective manner to inform clinicians, parents and managers. Given its importance, Commissioners of Health Care Services should be encouraged to identify appropriate funding for such data collection and analysis as part of the development of managed clinical networks [19].

Acknowledgements

Funding was initially received from regional audit funds, funding from regional research and development and from the Anglia Clinical Audit and Effectiveness Team in Cambridge was added at a later date.

We gratefully acknowledge the contribution of Gillian Gandy, Colin Morley and Janet Rennie, Carol Hay of CEMACH and the members of the VLBW project group: John Chapman, Hilary Dixon, Elizabeth Dryburgh, Julian Eason, Miranda East, Ian Evans, Matthew James, Gillian Lister, Richard Miles, Kevin

References (19)

  • D.K. Stevenson et al.

    Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994

    Am J Obstet Gynecol

    (1998)
  • House of Commons Health Care Services Committee

    2nd Report on Maternity Services

    (1992)
  • O. Claris et al.

    Neonatal mortality and morbidity of low birth weight premature infants (less than or equal to 1500 g)

    Pediatrie

    (1991)
  • S.K. Lee et al.

    Variations in practice and outcomes in the Canadian NICU network: 1996–1997

    Pediatrics

    (2000)
  • Office of Population Censuses and Surveys. London; 2001. available at http://www.statistics.gov.uk/census2001, accessed...
  • D.W. Milligan

    Neonatal intensive care provision in the United Kingdom 1992–3. British association of perinatal medicine

    Arch Dis Child Fetal Neonatal Ed

    (1997)
  • D. Field et al.

    Bench marking and performance management in neonatal care: easier said than done!

    Arch Dis Child Fetal Neonatal Ed

    (2002)
  • NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes

    Effect of corticosteroids for fetal maturation on perinatal outcomes

    JAMA

    (1995)
  • D. Nugent et al.

    The effects of female age on fecundity and pregnancy outcome

    Hum Fertil (Camb)

    (2001)
There are more references available in the full text version of this article.

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On behalf of the East Anglian Very Low Birthweight Project.

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