Trends in stillbirths and neonatal deaths for very pre-term infants (< 32 weeks' gestation) born in Victoria, 1986-1993

The impact of level of neonatal care provision on outcomes for preterm babies born between 27 and 31 weeks of gestation, or with a birth weight between 1000 and 1500 g: a review of the literature

OBJECTIVE

There is evidence that birth and care in a maternity service associated with a neonatal intensive care unit (NICU) is associated with improved survival in preterm babies born at <27 weeks of gestation. We conducted a systematic review to address whether similar gains manifested in babies born between 27+0 and 31+6 weeks (hereafter 27 and 31 weeks) of gestation, or in those with a birth weight between 1000 and 1500 g.

METHODS

We searched Embase, Medline and CINAHL databases for studies comparing outcomes for babies born between 27 and 31 weeks or between 1000 and 1500 g birth weight, based on designation of the neonatal unit where the baby was born or subsequently cared for (NICU vs non-NICU setting). A modified QUIPS (QUality In Prognostic Studies) tool was used to assess quality.

RESULTS

Nine studies compared outcomes for babies born between 27 and 31 weeks of gestation and 11 studies compared outcomes for babies born between 1000 and 1500 g birth weight. Heterogeneity in comparator groups, birth locations, gestational age ranges, timescale for mortality reporting, and description of morbidities facilitated a narrative review as opposed to a meta-analysis.

CONCLUSION

Due to paucity of evidence, significant heterogeneity and potential for bias, we were not able to answer our question-does place of birth or care affect outcomes for babies born between 27 and 31 weeks? This supports the need for large-scale research to investigate place of birth and care for babies born in this gestational age range.

Factors associated with fall in neonatal intubation rates in the United Kingdom - prospective study

OBJECTIVE

To investigate the trend of neonatal resuscitation by intubation or mask ventilation over time and to assess its association with changes in prevalence of caesarean section and use of general anaesthesia in labour.

METHODS

All women booking pregnancy at any of 15 maternity units, analysed using logistic regression.

DESIGN

Prospective study.

SETTING

UK hospital-based maternity units (15 centres).

POPULATION

A total of 221,322 first singleton births of babies weighing 200 g or more in the St Mary's Maternity Information System cohort, 1988-2000, covering the North West Thames area of London.

MAIN OUTCOME MEASURES

Prevalence of intermittent positive-pressure ventilation (IPPV) (by intubation or mask) by calendar year.

RESULTS

Overall use of IPPV decreased markedly (two-sided P<0.01) over the course of the study, and this decrease was evident by all modes of delivery. Adjusted mean prevalence of intubated IPPV decreased from 0.51% (95% CI 0.44-0.58) in 1988 to 0.07% (95% CI 0.06-0.09) in 2000. There was a similar decrease in the prevalence of IPPV by mask. However, despite substantial increases in prevalence of caesarean sections and reductions in the use of general anaesthesia over the course of the study, adjusting for these variables made little difference to the temporal trends in intubation or use of mask ventilation.

CONCLUSIONS

There has been a marked reduction in the prevalence of infants given resuscitation by positive-pressure ventilation that cannot be explained by changes in the prevalence of caesarean section or use of general anaesthesia in labour.