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 Ea st Anglia.2.To demonstrate a cost-effective method of region...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 Ea st Anglia.2.To demonstrate a cost-effective method of regional data collectio n.3.To determine whether there were any changes in the demand for neonatal car e.Study design and subjects:A prospective cohort analysis using a single datab ase to collect data on 1244 very low birthweight infants from eight neonatal uni ts in one Region from 1993 to 1997.Results:Estimated ascertainment of VLBW inf ants 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 significantl y decreased with increasing gestational age at birth.Compared to 22-25-week o ld 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 birthw eight,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,a lthough a significant increase was seen in the number of infants dying in delive ry rooms.There was a reduction in the reported incidence of pulmonary interstit ial emphysema(10-4%)but no change in the number of ventilation days or the r ate 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 5 9%)and was associated with a decreased risk of mortality(OR 0.44,95%CI:0.3 1-0.62).Conclusions:It is possible to collect useful data from the neonatal p eriod at a reasonable cost from a geographically defined population.This inform ationwas used for informing clinicians,counselling parents and in the era of ma naged clinical networks will be useful in guiding the provision of effective hea lth care resources.展开更多
Aim:To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disabil...Aim:To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability.Study design:A prospective cohort analysis from all eight neonatal units in East Anglia from 1 993—1997 using a single database.Methods:Local paediatricians assessed childr en at 2 years using the Health Status Questionnaire and data collection was cent rally coordinated.Results:Outcomes for 947 children,99%of survivors,were av ailable,74(7.8%)had severe disability and this was significantly associated with gestational age(p < 0.0005),birthweight(p < 0.0005)and sex(p = 0.046).Major congenital abnormality contributed 27%of all severe disability.The over all cerebral palsy rate was 6.2%,nine children were blind and five had sensori neural hearing loss requiring aids.These children had a high level of use of co mmunity services with 19%of the cohort being referred to one or more community service.ELBW infants or those born < 30 weeks gestation were 1.5 times and twic e as likely to have moderate or severe disability and 2.3 and 5.4 times as likel y to have cerebral palsy as those weighing 1000 to 1500 g or > 30 weeks gestatio n.Boys were at higher risk of adverse outcome.Conclusions:The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.展开更多
文摘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 Ea st Anglia.2.To demonstrate a cost-effective method of regional data collectio n.3.To determine whether there were any changes in the demand for neonatal car e.Study design and subjects:A prospective cohort analysis using a single datab ase to collect data on 1244 very low birthweight infants from eight neonatal uni ts in one Region from 1993 to 1997.Results:Estimated ascertainment of VLBW inf ants 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 significantl y decreased with increasing gestational age at birth.Compared to 22-25-week o ld 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 birthw eight,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,a lthough a significant increase was seen in the number of infants dying in delive ry rooms.There was a reduction in the reported incidence of pulmonary interstit ial emphysema(10-4%)but no change in the number of ventilation days or the r ate 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 5 9%)and was associated with a decreased risk of mortality(OR 0.44,95%CI:0.3 1-0.62).Conclusions:It is possible to collect useful data from the neonatal p eriod at a reasonable cost from a geographically defined population.This inform ationwas used for informing clinicians,counselling parents and in the era of ma naged clinical networks will be useful in guiding the provision of effective hea lth care resources.
文摘Aim:To determine the type and rate of disability at 2 years of age in infants born in the geographically defined population of East Anglia with a birthweight less than 1500 g and to assess the risk factors for disability.Study design:A prospective cohort analysis from all eight neonatal units in East Anglia from 1 993—1997 using a single database.Methods:Local paediatricians assessed childr en at 2 years using the Health Status Questionnaire and data collection was cent rally coordinated.Results:Outcomes for 947 children,99%of survivors,were av ailable,74(7.8%)had severe disability and this was significantly associated with gestational age(p < 0.0005),birthweight(p < 0.0005)and sex(p = 0.046).Major congenital abnormality contributed 27%of all severe disability.The over all cerebral palsy rate was 6.2%,nine children were blind and five had sensori neural hearing loss requiring aids.These children had a high level of use of co mmunity services with 19%of the cohort being referred to one or more community service.ELBW infants or those born < 30 weeks gestation were 1.5 times and twic e as likely to have moderate or severe disability and 2.3 and 5.4 times as likel y to have cerebral palsy as those weighing 1000 to 1500 g or > 30 weeks gestatio n.Boys were at higher risk of adverse outcome.Conclusions:The study was able to define the increased risk associated with being born at lower gestational age or lower birthweight and demonstrates successful ascertainment of outcomes for large local populations at a reasonable cost.
