title: Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009.
abstract: OBJECTIVE
  To identify changes in clinical practices for infants with birth weights of 501 to 1500 g born from 2000 to 2009.
  
  
  METHODS
  We used prospectively collected registry data for 355,806 infants born from 2000 to 2009 and cared for at 669 North American hospitals in the Vermont Oxford Network. Main outcome measures included obstetric and neonatal practices, including cesarean delivery, antenatal steroids, delivery room interventions, respiratory practices, neuroimaging, retinal exams, and feeding at discharge.
  
  
  RESULTS
  Significant changes in many obstetric, delivery room, and neonatal practices occurred from 2000 to 2009. Use of surfactant treatment in the delivery room increased overall (adjusted difference [AD] 17.0%; 95% confidence interval [CI] 16.4% to 17.6%), as did less-invasive methods of respiratory support, such as nasal continuous positive airway pressure (AD 9.9%; 95% CI 9.1% to 10.6%). Use of any ventilation (AD -7.5%; 95% CI -8.0% to -6.9%) and steroids for chronic lung disease (AD -15.3%; 95% CI -15.8% to -14.8%) decreased significantly overall. Most of the changes in respiratory care were observed within each of 4 birth weight strata (501-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g).
  
  
  CONCLUSIONS
  Many obstetric and neonatal care practices used in the management of infants 501 to 1500 g changed between 2000 and 2009. In particular, less-invasive approaches to respiratory support increased.
authors.affiliation: Department of Pediatrics, University of Vermont, Burlington, Vermont 05401, USA. roger.soll@vtmednet.org
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
authors.forename: Erika M
authors.initials: EM
authors.lastname: Edwards
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Badger
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kenny
authors.forename: Kate A
authors.initials: KA
authors.lastname: Morrow
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Buzas
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Horbar
mesh_terms: D005544:Forecasting; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000639:trends; D009359:Neonatology / Q000379:methods / Q000639:trends*; D009656:North America; D009774:Obstetrics / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D012042:Registries
keywords: NICU; Vermont Oxford Network; interventions; practice; very low birth weight