Objective To determine if survival rates of preterm infants receiving active perinatal care improve over time.
Design The German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016.
Setting 43 German level III neonatal intensive care units (NICUs).
Patients 8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care.
Interventions Participating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25–P75) and low (<P25) survival. We compared these survival rates with data in 2014–2016.
Main outcome measures Death by any cause before discharge.
Results Total survival increased from 85.8% in 2011–2013 to 87.4% in 2014–2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011–2013. Survival increased in these centres from 53% to 64% in the 22–24 weeks strata and from 73% to 84% in the 25–26 weeks strata.
Conclusions Our data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered.
Trial registration Approval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08–022) and by the local ethic committees of all participating centres has been given.
- outcomes research
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Contributors Conceived and designed the experiments: WG, EH, AH, CH. Analysed the data: WG, CH, AH, TKR. Contributed reagents/materials/analysis tools: EH, WG, CH, ChW, VDW, AK, GS, DMO, UW, TH, DMO, UF-M, RR, NT, FH, KL, SuS, BB, MV, HS, JM, JGE, JW, RB, MeH, MD, GH, CR, RJ, MZ, MM, CW, StS, TS, AF, MH, SE, OK, TO, HG, RH, KB, KL, KS, PS. Wrote the paper: AH, CH, WG, EH. The authors have given final approval of the version to be published. Each author participated sufficiently in the work to take public responsibility for appropriate portions of the content, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The German Neonatal Network is funded by the German Ministry of Education and Research (BMBF grant no: 01ER0805 and 01ER1501). The funder had no involvement in this study.
Disclaimer The sponsor had no role in study design; collection, analysis and interpretation of data; writing of the report; and the decision to submit the paper for publication.
Competing interests None declared.
Ethics approval Written informed consent was obtained from the parents on behalf of the infants enrolled in our study. The study parts were approved by the local committee on research in human subjects of the University of Luebeck (08–022; 03.12.2010) and the local ethical committees at the other study centres, specifically the Ethical Board of the Medical Chamber of the North Rhine region, Ethical Board of the University of Aachen, Ethical Board of the University of Bonn, Ethical Board of the Medical Chamber of the federal state of Mecklenburg-Vorpommern, Ethical Board of the Medical Chamber of Berlin, Ethical Board of the University of Magdeburg, Ethical Board of the University of Halle, Ethical Board of the University of Tübingen, Ethical Board of the Medical School Hannover, Ethical Board of the University of Cologne, Ethical Board of the University of Essen, Ethical Board of the Medical Chamber of the Westphalia-Lippe region, Ethical Board of the Medical Chamber of Hamburg, Ethical Board of the Medical Chamber of the federal state of Hessen, Ethical Board of the Medical Chamber of the federal state of Baden-Württemberg, Ethical Board of the Medical Chamber of the federal state of Bavaria, and Ethical Board of Saar University.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data sets generated and analysed during the current study are not publicly available but can be reviewed on reasonable request.
Patient consent for publication Not required.
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