Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison.

OBJECTIVE: To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. STUDY DESIGN: We included 58 004 infants born weighing <1500 g at 24(0)-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses. RESULTS: Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons. CONCLUSIONS: We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.

Risk Factors for Periventricular Echodensities and Neurologic Outcome in Preterm Infants

PURPOSE: In preterm infants with brain injury, periventricular echodensity is increased transiently or becomes cyst with neurologic sequelae. This study was done to identify the infants who need early rehabilitation treatment by evaluating the risk factors and neurologic outcome in cystic change group and transient echodensity group. METHODS: Thirty one preterm infants with periventricular echodensity on cranial ultrasonography were divided into cystic change group and transient echodensity group. The prenatal, natal, postnatal risk factors and neurologic outcome were evaluated in each group. RESULTS: The risk factors for periventricular cystic change included gestational age, ventilator use, oxygen administration, surfactant use and anemia. The risk factors for transient periventricular echodensity were the same as the cystic change group except gestational age. The development of cerebral palsy occurred in 3 cases out of 10 cases, 2 cases out of 21 cases in each group. CONCLUSION: The preterm infants with periventricular cysts or transient periventricular echodensity need to be observed closely for the development of adverse neurological outcomes especially of those with aforementioned risk factors.

Risk Factors for Periventricular Echodensities and Neurologic Outcome in Preterm Infants

PURPOSE: In preterm infants with brain injury, periventricular echodensity is increased transiently or becomes cyst with neurologic sequelae. This study was done to identify the infants who need early rehabilitation treatment by evaluating the risk factors and neurologic outcome in cystic change group and transient echodensity group. METHODS: Thirty one preterm infants with periventricular echodensity on cranial ultrasonography were divided into cystic change group and transient echodensity group. The prenatal, natal, postnatal risk factors and neurologic outcome were evaluated in each group. RESULTS: The risk factors for periventricular cystic change included gestational age, ventilator use, oxygen administration, surfactant use and anemia. The risk factors for transient periventricular echodensity were the same as the cystic change group except gestational age. The development of cerebral palsy occurred in 3 cases out of 10 cases, 2 cases out of 21 cases in each group. CONCLUSION: The preterm infants with periventricular cysts or transient periventricular echodensity need to be observed closely for the development of adverse neurological outcomes especially of those with aforementioned risk factors.

A Study of Progression to Cerebral Palsy in Premature Infants with Neurosonographic Abnormal Findings

PURPOSE: Although neonatal intensive care and development of obstetrics play a role in improving survival rate in prematurity, cerebral palsy (CP) is still one of the neurologic sequelae. We tried to find what kinds of risk factors in the patients with abnormal neurosonographic findings who developed CP later. This study was performed to predict early enough who will develop CP later and to treat rapidly for rehabilitation. METHODS: The one hundred and forty one infants with intraventricular hemorrhage, cyst, or abnormal increased periventricular echodensity in serial neurosonographic findings were admitted to the neonatal intensive care unit of Gil general hospital from January 1992 to December 1994. Neurosonographic findings in CP group and non-CP group during postpartum 18 months to 54 months were analysed retrospectively. RESULTS: 1) 18 of one hundred and forty one cases with abnormal neurosonographic findings developed CP. The duration of mechanical ventilation of the CP group was 11.6+/-16.1 days. It is significantly shorter than that of the control group (non-CP group : 2.2+/-7.0 day). The duration of oxygen therapy in the CP group was 22.4+/-19.2 days. Which is also significantly shorter than that of the control group (non-CP group : 5.4+/-8.4 day) (P<0.01). 2) Increased periventricular echodensity and the size of the cyst in neurosonographic findings in the CP group is significantly different from those of the non-CP group P<0.01). 3) In CP group (N=18), Increased periventricular echodensity and cyst formation were located most commonly in the parietal region. 4) The grade of the intraventricular hemorrhage in the CP group was significantly different from that in the non-CP group (P<0.01). 5) The neurosonographic findings give the diagnostic accuracy for predicting CP. CONCLUSIONS: We studied the relationship of the abnormal neurosonographic findings, CP, and associated risk factors. In review, By using neurosonographic examination the risk of the development of CP could be predicted, and by early diagnosis of CP the quality of the life of CP-patient could be better.