Active perinatal care of preterm infants in the German Neonatal Network.
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Humberg Alexander, Härtel Christoph, Rausch Tanja K, Stichtenoth Guido, Jung Philipp, Wieg Christian, Kribs Angela, von der Wense Axel, Weller Ursula, Höhn Thomas, Olbertz Dirk M, Felderhoff-Müser Ursula, Rossi Rainer, Teig Norbert, Heitmann Friedhelm, Schmidtke Susanne, Bohnhorst Bettina, Vochem Matthias, Segerer Hugo, Möller Jens, Eichhorn Joachim G, Wintgens Jürgen, Böttger Ralf, Hubert Mechthild, Dördelmann Michael, Hillebrand Georg, Roll Claudia, Jensen Reinhard, Zemlin Michael, Mögel Michael, Werner Claudius, Schäfer Stefan, Schaible Thomas, Franz Axel, Heldmann Michael, Ehlers Silke, Kannt Olaf, Orlikowsky Thorsten, Gerleve Hubert, Schneider Katja, Haase Roland, Böckenholt Kai, Linnemann Knud, Herting Egbert, Göpel Wolfgang
Аннотация
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.