1. In a retrospective cohort study of almost 50 000 very low birth weight infants (VLBW), overall survival without major morbidity increased significantly between 2008 and 2017.
2. The largest improvements in major morbidity rates were seen for nosocomial infection (NI) and necrotizing enterocolitis (NEC), while the rates of bronchopulmonary dysplasia (BPD) and cystic periventricular leukomalacia (PVL) were unchanged.
Evidence Rating Level: 2 (Good)
Study Rundown: Very low birthweight (VLBW) infants, those born at <1500g, are at increased risk for serious morbidity and death from a multitude of causes. Although California has taken a collaborative approach to examining efforts aimed at reducing these complications, no long-term evaluation of survival without major morbidity in this system has been completed. This retrospective cohort study analyzed long-term survival without major morbidity among VLBW infants across 142 NICUs in California between 2008 and 2017. Major morbidity was defined as infant death occurring during birth hospitalization, BPD, severe intraventricular hemorrhage (IVH), NI, NEC, severe retinopathy of prematurity (ROP), and cystic PVL. During the study period, overall survival without major morbidity improved, however rates of BPD and PVL were unchanged. There was also a significant decrease in variation of survival without major morbidity between hospitals. It was noted that if all hospitals performed as well as those in the top quartile, there would have been an additional 6.6% improvement per year in overall survival without major morbidity. Overall, the study highlights important achievements in neonatal care of VLBW infants as well as potential areas for continued improvement.
In-Depth [retrospective cohort]: The study population included infants born between 2008 and 2017 with a birth weight between 401 to 1500 grams or a gestational age between 22 and 29 weeks from 142 NICUs in the California Perinatal Quality Care Collaborative (CPQCC). The median gestational age was 28 weeks (IQR 26-30 weeks). Infants with severe congenital anomalies and those who died in the delivery room were excluded. A total of 49 333 infants (51.9% male, 45.1% Hispanic) were included in the final analysis. Overall survival without major morbidity improved by 7.6% (p < 0.001), while rates of BPD and PVL were unchanged. The largest change was seen among infants <25 (18.7% improvement) and 25-27 (16.5%) weeks’ gestation. Trends in individual morbidities were also examined; the largest improvements were seen in NI (44.7% decreased incidence, p < 0.001) and NEC (-45.6%, p < 0.001). Statistically significant improvements were also seen in severe ROP (-36.4%, p < 0.001) and IVH (-20.4%, p < 0.001). Rates of PVL and BPD were not significantly changed during the study period. In infants who survived with a major morbidity, the number of morbidities decreased over time.
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