Changing availability of neonatal intensive care for extremely low birthweight infants in Victoria over two decades.
نویسنده
چکیده
OBJECTIVE To determine the changes in availability of neonatal intensive care for extremely low birthweight (ELBW) infants, and the consequences of a lack of availability. DESIGN AND SETTING Population-based cohort study of consecutive ELBW infants born in the state of Victoria during four distinct eras. PARTICIPANTS All livebirths weighing 500-999 g in Victoria in the calendar years 1979-1980 (n = 351), 1985-1987 (n = 560), 1991-1992 (n = 429), and 1997 (n = 233). MAIN OUTCOME MEASURES Changes over time in the proportions of ELBW infants offered intensive care, the proportions that were "outborn" (born outside level 3 perinatal centres), and their survival rates and quality of survival compared with "inborn" infants. RESULTS The proportions of ELBW infants offered intensive care increased over time and were significantly higher in heavier infants. The proportion of outborn ELBW infants was 30% in 1979-1980, falling to 9% by 1997. The difference in survival rates between inborn and outborn infants widened progressively over time: the survival advantages for inborn infants over outborn infants were 12.0% in 1979-1980, 30.1% in 1985-1987, 36.5% in 1991-1992, and 43.6% in 1997. For survivors, the quality of life was significantly better for inborn infants in two of the four eras. CONCLUSIONS Neonatal intensive care has been increasingly available for ELBW infants in Victoria over the period 1979 to 1997. The gap in survival rates between outborn and inborn infants has widened, and the quality of life of outborn survivors is inferior.
منابع مشابه
Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: II. Efficiency
متن کامل
Variations in the quality of care for very-low-birthweight infants: implications for policy.
Much of the decline in childhood mortality over the past two decades is attributable to improvements in neonatal intensive care for very-low-birthweight infants. Yet large and persistent disparities persist in the quality of neonatal intensive care across hospitals. Improving care for infants now served by hospitals with poor outcomes can greatly reduce infant mortality, particularly among mino...
متن کاملEvaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades: I. Effectiveness.
CONTEXT Although individual components of neonatal intensive care have proven efficacy, doubts remain about its overall effectiveness. OBJECTIVE To determine the changes in effectiveness of neonatal intensive care for extremely low birth weight (ELBW) infants over 2 decades. DESIGN Population-based cohort study of consecutive ELBW infants born during 4 distinct eras: 1979-1980, 1985-1987, 1...
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OBJECTIVE To assess whether risk-adjusted mortality in very low birthweight or preterm infants is associated with levels of nursing provision. DESIGN Prospective study of risk-adjusted mortality in infants admitted to a random sample of neonatal units. SETTING Fifty four UK neonatal intensive care units stratified by: patient volume; consultant availability; nurse:cot ratios. PATIENTS A g...
متن کاملCerebral palsy and newborn care. II: Mortality and neurological impairment in low-birthweight infants.
In recent years, neonatal mortality rates for low-birthweight infants have declined both in neonatal intensive care units and in several populations in the industrialized world. With regard to impairment among surviving low-birthweight infants, studies from newborn intensive care units show considerable variation in the reported rates of handicaps. Much of this variation arises from a lack of u...
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ورودعنوان ژورنال:
- The Medical journal of Australia
دوره 181 3 شماره
صفحات -
تاریخ انتشار 2004