Morbidity And Mortality In Very Low Birth Weight Infants: A Comparison Of Two Five-Year Periods With A 15-Year Interval

Öz

Introduction and methods: Thanks to developments in perinatal and neonatal care, the survival rate of premature babies has increased. Depending on the development level of countries and units, some of the morbidity rates may increase, while others may decrease. In this retrospective cross-sectional study; the morbidity and mortality results of very low birth weight (VLBW) infants were evaluated by comparing the results of the infants in our previous study and the data of developed countries. Results: 203 infants were included in the last group. The mean birth weight of these babies was 976±308 g and the mean gestational age was 27.8±2.5 weeks. The rate of babies with a gestational age of 28 weeks and above were significantly lower than the first group containing 173 infants. Regarding major morbidities, the rates of bronchopulmonary dysplasia (moderate to severe) and necrotizing enterocolitis (>stage 2) were significantly higher in the last group; while the rates of retinopathy of prematurity (>grade 2), intraventricular hemorrhage (>grade 2) and periventricular leukomalacia were also similar among the two groups. While survival rates were found to be similar, the survival rate without major morbidity was significantly lower in the last group. Conclusion: While the survival rates remained unchanged despite the observation of smaller babies in terms of birth weight and gestational age in the last period when mortality and morbidity data were compared with developed countries, the study demonstrated a need for improvement in mortality rates especially in small gestational weeks, while major morbidity rates were generally encouraging.

Anahtar Kelimeler

• morbidity
• mortality
• very low birth weight
• newborn

Yenidoğan Yoğun Bakım Ünitesinde İzlenen Çok Düşük Doğum Ağırlıklı Bebeklerde Morbidite Ve Mortalite Sonuçları: 15 Yıl Arayla İki Beş Yıllık Dönemin Karşılaştırılması

Öz

Giriş ve yöntemler: Perinatal ve neonatal bakımdaki gelişmeler sayesinde prematüre bebeklerin yaşama oranları artmıştır. Ülkelerin ve birimlerin gelişmişlik düzeyine bağlı olarak bazı morbidite oranları artabilir, bazılarında ise azalabilir. Bu retrospektif kesitsel çalışmada; çok düşük doğum ağırlıklı (ÇDDA) bebeklerin morbidite ve mortalite sonuçları önceki çalışmamızdaki bebeklerin sonuçları ile gelişmiş ülke verileri karşılaştırılarak değerlendirildi. Bulgular: Son gruba 203 bebek dahil edildi. Bu bebeklerin ortalama doğum ağırlıkları 976±308 gr ve ortalama gebelik haftaları 27,8±2,5 hafta idi. Gebelik yaşı 28 hafta ve üzerinde olan bebeklerin oranı, 173 bebek içeren ilk gruba göre anlamlı derecede düşüktü. Majör morbiditelerle ilgili olarak, bronkopulmoner displazi (orta ila şiddetli) ve nekrotizan enterokolit (>evre 2) oranları son grupta anlamlı olarak daha yüksekti; prematüre retinopatisi (>derece 2), intraventriküler kanama (>derece 2) ve periventriküler lökomalazi oranları da iki grup arasında benzerdi. Sağkalım oranları benzer bulunurken, majör morbidite olmaksızın sağkalım oranı son grupta anlamlı olarak daha düşüktü. Çözüm: Mortalite ve morbidite verileri gelişmiş ülkelerle karşılaştırıldığında son dönemde doğum ağırlığı ve gebelik yaşı açısından daha küçük bebeklerin görülmesine rağmen sağkalım oranları değişmedi. Çalışma, özellikle küçük gebelik haftalarında ölüm oranlarında iyileşmeye ihtiyaç olduğunu gösterirken, majör morbidite oranları genellikle cesaret vericiydi.

Anahtar Kelimeler

• morbidite
• mortalite
• çok düşük doğum ağırlığı
• yenidoğan

Kaynakça

1. 1. Horbar JD, Wright EC, Onstad L. Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601 to 1300 grams at birth. The Members of the National Institute of Child Health and Human Development Neonatal Research Network. Pediatrics. 1993;92(2):191-6.
2. 2. Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. lancet 2008;371(9607):164-75.
3. 3. Koc E, Demirel N, Bas AY, Ulubas Isik D, Hirfanoglu IM, Tunc T, et al. Early neonatal outcomes of very-low-birth-weight infants in Turkey: A prospective multicenter study of the Turkish Neonatal Society. PLoS One. 2019;14(12):e0226679.
4. 4. Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH, et al. INTERGROWTH-21st very preterm size at birth reference charts. lancet 2016;387(10021):844-5.
5. 5. Giuliani F, Cheikh Ismail L, Bertino E, Bhutta ZA, Ohuma EO, Rovelli I, et al. Monitoring postnatal growth of preterm infants: present and future. AmJ Clin Nutr. 2016;103(2):635S-47S.
6. 6. Villar J, Giuliani F, Bhutta ZA, Bertino E, Ohuma EO, Ismail LC, et al. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. Lancet Globe Health. 2015;3(11):e681-91.
7. 7. Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin Neonatol. 2003;8(6):449-59.
8. 8. Koç E YBA, Özdek S, Ovalı F, Başmak H. Turkish Neonatal and Turkish Ophthalmology Societies consensus guideline on the retinopathy of prematurity. Turk Pediatrics Ars. 2018;53(Suppl 1):151-60.

9. 9. Köksal N AC, Uras N. T Turkish Neonatal Society guideline on the management of patent ductus arteriosus in preterm infants. Turk Pediatrics Ars. 2018:76-87.
10. 10. Özkan H EÖ, Kanmaz Kutman HG. Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment. Turk Pediatrics Ars. 2018;53(Suppl 1)(53(Suppl 1)):45-54.
11. 11. Satar M EAA, Çelik İH. Turkish Neonatal Society guideline on neonatal infections - diagnosis and treatment. Turk Pediatrics Ars 2018; 53(Suppl 1):88-100.
12. 12. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529-34.
13. 13. de Vries LS, Dubowitz LM, Dubowitz V, Kaiser A, Lary S, Silverman M, et al. Predictive value of cranial ultrasound in the newborn baby: a reappraisal. lancet 1985;2(8447):137-40.
14. 14. Duman N, Kumral A, Gulcan H, Ozkan H. Outcome of very-low-birth-weight infants in a developing country: a prospective study from the western region of Turkey. J Matern Fetal Neonatal Med. 2003;13(1):54-8.
15. 15. Horbar JD, Plsek PE, Leahy K, Nic/Q. NIC/Q 2000: establishing habits for improvement in neonatal intensive care units. Pediatrics. 2003;111(4 Pt 2):e397-410.
16. 16. Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics. 2012;129(6):1019-26.
17. 17. Grandi C, Gonzalez A, Zubizarreta J, Red Neonatal N. Perinatal factors associated with neonatal mortality in very low birth weight infants: a multicenter study. Arch Argent Pediatr. 2016;114(5):426-33.
18. 18. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443-56.
19. 19. Tuzun F, Yucesoy E, Baysal B, Kumral A, Duman N, Ozkan H. Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants. J Matern Fetal Neonatal Med. 2018;31(17):2252-7.
20. 20. H. William Taeusch SEJ. Care of the extremely low-birth-weight infant. Avery's diseases of the newborn. Amsterdam: Elsevier; 2017.