Changes in perinatal care and survival in very preterm and extremely preterm infants in The Netherlands between 1983 and 1995.
OBJECTIVE
To evaluate changes in obstetrical and neonatal care for very preterm and extremely preterm infants between 1983 and 1995 in The Netherlands and to evaluate the effect of those changes.


METHODS
Data on all very preterm or VLBW infants from the linked national obstetrical and neonatal databases of 1995 (N=2066) were compared to data on similar infants from a nation-wide study of very preterm infants born in 1983 (N=1338).


RESULTS
Obstetrical and neonatal management changed over time, with an increased number of deliveries in tertiary centres (35.7-60.7%), an increase in C-sections (43.7-56.8%) and prolonged artificial ventilation (3.4-9.5%). Survival until discharge increased from 75 to 90% and neonatal morbidity decreased in relative terms.


CONCLUSIONS
The short-term outcome for these very preterm and extremely preterm infants has improved. Long-term follow-up through to school age and adulthood of preterm infants is needed to investigate the changes in the sequelae of intensive obstetrical and neonatal care.
Anthony
Sabine
S
Child Health Division, TNO Prevention and Health, PO Box 92215, 2301 CE Leiden, The Netherlands. s.anthony@pg.tno.nl
Ouden
Lya den
Ld
Brand
Ronald
R
Verloove-Vanhorick
Pauline
P
Gravenhorst
Jack Bennebroek
JB
D001034:Apgar Score; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D018743:Perinatal Care / Q000592:standards* / Q000639:trends; D011247:Pregnancy; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis