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

Pauline E 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 journalArticleAcademicpeer-review


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 languageEnglish
JournalArchives of Disease in Childhood-Fetal and Neonatal Edition
Publication statusE-pub ahead of print - 6 Nov 2020


  • mortality
  • neonatology

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