Survival and causes of death in extremely preterm infants in the Netherlands

Pauline van Beek; Floris Groenendaal; Lisa Broeders; Peter H. Dijk; Koen P. Dijkman; Frank A.M. van den Dungen; Arno F.J. van Heijst; Jacqueline L. van Hillegersberg; René F. Kornelisse; Wes Onland; Frank A.B.A. Schuerman; Elke van Westering-Kroon; Ruben S.G.M. Witlox; Peter Andriessen

doi:10.1136/archdischild-2020-318978

Survival and causes of death in extremely preterm infants in the Netherlands

Pauline van Beek (Corresponding author), Floris Groenendaal, Lisa Broeders, Peter H. Dijk, Koen P. Dijkman, Frank A.M. van den Dungen, Arno F.J. van Heijst, Jacqueline L. van Hillegersberg, René F. Kornelisse, Wes Onland, Frank A.B.A. Schuerman, Elke van Westering-Kroon, Ruben S.G.M. Witlox, Peter Andriessen

Research output: Contribution to journal › Article › Academic › peer-review

36 Citations (Scopus)

Abstract

OBJECTIVE: In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.

DESIGN: National cohort study, using data from the Netherlands Perinatal Registry.

PATIENTS: The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.

MAIN OUTCOME MEASURES: Survival to discharge, as well as cause and timing of death.

RESULTS: After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006).

CONCLUSIONS: Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.

Original language	English
Pages (from-to)	F251-F257
Number of pages	7
Journal	Archives of Disease in Childhood : Fetal and Neonatal Edition
Volume	106
Issue number	3
Early online date	6 Nov 2020
DOIs	https://doi.org/10.1136/archdischild-2020-318978
Publication status	Published - 1 May 2021

Keywords

mortality
neonatology
Enterocolitis, Necrotizing/mortality
Infant Mortality
Intensive Care Units, Neonatal/statistics & numerical data
Infant, Very Low Birth Weight
Humans
Infant
Male
Gestational Age
Hospital Mortality/trends
Cause of Death/trends
Neonatal Sepsis/mortality
Respiratory Distress Syndrome, Newborn/mortality
Time Factors
Survival Analysis
Female
Infant, Extremely Premature
Stillbirth/epidemiology
Netherlands/epidemiology
Infant, Newborn
Infant, Premature, Diseases/mortality
Cohort Studies

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/archdischild-2020-318978

Cite this

van Beek, P., Groenendaal, F., Broeders, L., Dijk, P. H., Dijkman, K. P., van den Dungen, F. A. M., van Heijst, A. F. J., van Hillegersberg, J. L., Kornelisse, R. F., Onland, W., Schuerman, F. A. B. A., van Westering-Kroon, E., Witlox, R. S. G. M., & Andriessen, P. (2021). Survival and causes of death in extremely preterm infants in the Netherlands. Archives of Disease in Childhood : Fetal and Neonatal Edition, 106(3), F251-F257. https://doi.org/10.1136/archdischild-2020-318978

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title = "Survival and causes of death in extremely preterm infants in the Netherlands",

abstract = "OBJECTIVE: In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.DESIGN: National cohort study, using data from the Netherlands Perinatal Registry.PATIENTS: The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.MAIN OUTCOME MEASURES: Survival to discharge, as well as cause and timing of death.RESULTS: After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006).CONCLUSIONS: Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.",

keywords = "mortality, neonatology, Enterocolitis, Necrotizing/mortality, Infant Mortality, Intensive Care Units, Neonatal/statistics & numerical data, Infant, Very Low Birth Weight, Humans, Infant, Male, Gestational Age, Hospital Mortality/trends, Cause of Death/trends, Neonatal Sepsis/mortality, Respiratory Distress Syndrome, Newborn/mortality, Time Factors, Survival Analysis, Female, Infant, Extremely Premature, Stillbirth/epidemiology, Netherlands/epidemiology, Infant, Newborn, Infant, Premature, Diseases/mortality, Cohort Studies",

author = "{van Beek}, Pauline and Floris Groenendaal and Lisa Broeders and Dijk, {Peter H.} and Dijkman, {Koen P.} and {van den Dungen}, {Frank A.M.} and {van Heijst}, {Arno F.J.} and {van Hillegersberg}, {Jacqueline L.} and Kornelisse, {Ren{\'e} F.} and Wes Onland and Schuerman, {Frank A.B.A.} and {van Westering-Kroon}, Elke and Witlox, {Ruben S.G.M.} and Peter Andriessen",

note = "{\textcopyright} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = may,

day = "1",

doi = "10.1136/archdischild-2020-318978",

language = "English",

volume = "106",

pages = "F251--F257",

journal = "Archives of Disease in Childhood : Fetal and Neonatal Edition",

issn = "1359-2998",

publisher = "BMJ Publishing Group",

number = "3",

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van Beek, P, Groenendaal, F, Broeders, L, Dijk, PH, Dijkman, KP, van den Dungen, FAM, van Heijst, AFJ, van Hillegersberg, JL, Kornelisse, RF, Onland, W, Schuerman, FABA, van Westering-Kroon, E, Witlox, RSGM & Andriessen, P 2021, 'Survival and causes of death in extremely preterm infants in the Netherlands', Archives of Disease in Childhood : Fetal and Neonatal Edition, vol. 106, no. 3, pp. F251-F257. https://doi.org/10.1136/archdischild-2020-318978

TY - JOUR

T1 - Survival and causes of death in extremely preterm infants in the Netherlands

AU - van Beek, Pauline

AU - Groenendaal, Floris

AU - Broeders, Lisa

AU - Dijk, Peter H.

AU - Dijkman, Koen P.

AU - van den Dungen, Frank A.M.

AU - van Heijst, Arno F.J.

AU - van Hillegersberg, Jacqueline L.

AU - Kornelisse, René F.

AU - Onland, Wes

AU - Schuerman, Frank A.B.A.

AU - van Westering-Kroon, Elke

AU - Witlox, Ruben S.G.M.

AU - Andriessen, Peter

N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/5/1

Y1 - 2021/5/1

N2 - OBJECTIVE: In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.DESIGN: National cohort study, using data from the Netherlands Perinatal Registry.PATIENTS: The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.MAIN OUTCOME MEASURES: Survival to discharge, as well as cause and timing of death.RESULTS: After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006).CONCLUSIONS: Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.

AB - OBJECTIVE: In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation.DESIGN: National cohort study, using data from the Netherlands Perinatal Registry.PATIENTS: The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group.MAIN OUTCOME MEASURES: Survival to discharge, as well as cause and timing of death.RESULTS: After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006).CONCLUSIONS: Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.

KW - mortality

KW - neonatology

KW - Enterocolitis, Necrotizing/mortality

KW - Infant Mortality

KW - Intensive Care Units, Neonatal/statistics & numerical data

KW - Infant, Very Low Birth Weight

KW - Humans

KW - Infant

KW - Male

KW - Gestational Age

KW - Hospital Mortality/trends

KW - Cause of Death/trends

KW - Neonatal Sepsis/mortality

KW - Respiratory Distress Syndrome, Newborn/mortality

KW - Time Factors

KW - Survival Analysis

KW - Female

KW - Infant, Extremely Premature

KW - Stillbirth/epidemiology

KW - Netherlands/epidemiology

KW - Infant, Newborn

KW - Infant, Premature, Diseases/mortality

KW - Cohort Studies

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U2 - 10.1136/archdischild-2020-318978

DO - 10.1136/archdischild-2020-318978

M3 - Article

C2 - 33158971

SN - 1359-2998

VL - 106

SP - F251-F257

JO - Archives of Disease in Childhood : Fetal and Neonatal Edition

JF - Archives of Disease in Childhood : Fetal and Neonatal Edition

IS - 3

ER -

Survival and causes of death in extremely preterm infants in the Netherlands

Abstract

Keywords

UN SDGs

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Perinatal Medicine

Cite this

Survival and causes of death in extremely preterm infants in the Netherlands

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Research areas

Perinatal Medicine

Cite this