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 24 0/7 and 26 6/7 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.
|Journal||Archives of Disease in Childhood: Fetal and Neonatal Edition|
|Publication status||Published - 1 May 2021|
Bibliographical noteFunding Information:
Funding This project has been funded by an unrestricted grant from Stichting Tiny & Anny van Doorne Fonds.
1Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands 2Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands 3The Netherlands Perinatal Registry, Utrecht, The Netherlands 4Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands 5Department of Neonatology, VU University Medical Centre, Amsterdam, The Netherlands 6Department of Neonatology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands 7Department of Neonatology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands 8Department of Pediatrics, Devision of Neonatology, Sophia Children’s Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands 9Department of Neonatology, Emma Childrens Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands 10Department of Neonatology, Isala Clinics, Zwolle, The Netherlands 11Department of Neonatology, Maastricht University Medical Centre, Maastricht, The Netherlands 12Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands 13Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands Acknowledgements The EPI-DAF study group (steering committee members: Monique Rijken, Guid Oei and Peter Andriessen) and EPI-DAF PhD student (Pauline van Beek) are indebted to all collaborators, including paediatricians, psychologists and physiotherapists of all perinatal centres in the Netherlands: Amsterdam UMC location AMC (PI: Aleid van Wassenaer-Leemhuis), Amsterdam UMC location VUmc (PI: Céleste Laarman), Erasmus MC (PI: Renate Swarte), Isala Clinics (PI: Susanne Mulder-de Tollenaer), LUMC (PI: Monique Rijken), Maastricht UMC+ (PI: Elke van Westering-Kroon), Máxima MC (PI: Ellen de Kort), Radboud UMC (PI: Katerina Steiner), UMCG (PI: Henk ter Horst) and UMC Utrecht (PI: Corine Koopman-Esseboom). The EPI-DAF study group is also grateful for the support by the Netherlands Perinatal Registry (Perined; Lisa Broeders, Ger de Winter), the Dutch working group on Neonatal Follow-up (LNF; Cornelieke Aarnoudse-Moens, Monique Rijken, Renate Swarte), the Dutch National Neonatal Registry Working Group (LNR; Floris Groenendaal, René Kornelisse) and the Neonatology Network Netherlands (N3; Debbie Nuytemans, Wes Onland).
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