title: Population-based trends in mortality and neonatal morbidities among singleton, very preterm, very low birth weight infants over 16 years.
abstract: BACKGROUND
  Improved survival of singleton very preterm, very low birth weight (VPTVLBW) infants has been associated with increasing rates of severe neonatal morbidities.
  
  
  OBJECTIVE
  To assess changes in mortality and neonatal morbidities among singleton VPT-VLBW infants.
  
  
  METHODS
  Population-based observational study of data collected by the Israel Neonatal Network.
  
  
  METHODS
  10,705 singleton VPT-VLBW infants born at 24-32 gestational weeks in 1995-2010.
  
  
  METHODS
  Mortality and major neonatal morbidities over 3 time periods: 1995-2000, 2001-2005, and 2006-2010. Major neurological morbidities comprised intraventricular hemorrhage grades 3-4, periventricular leukomalacia and retinopathy of prematurity grades 3-4.
  
  
  RESULTS
  The mortality rate decreased over time from 20.2% to 13.8% for all birth weight and gestational age groups. Compared to the 1995-2000 period, the adjusted odds ratios (aORs) (95% confidence intervals,) for mortality in 2001-2005 and 2006-2010 were 0.78 (0.67-0.90) and 0.72 (0.62-0.84), respectively. The combined outcomes of death or major neurological morbidities, aOR 0.74 (0.65-0.84) and death or major neurological morbidities and/or bronchopulmonary dysplasia aOR 0.85 (0.75-0.96) decreased significantly between the first and last periods. A significant improvement in mortality rates and survival without one or more major neonatal morbidity was observed for all birth weight and gestational age groups. Among 8,886 surviving infants the rates of major neurological morbidities decreased from 16.4% to 12.8%, aOR 0.80 (0.68-0.95).
  
  
  CONCLUSIONS
  The improving survival of singleton VTP-VLBW infants was not associated with a concomitant increase in the risk for major neonatal neurological morbidities among surviving infants. Bronchopulmonary dysplasia, however, remained a significant burden. This analysis emphasizes the need to direct efforts towards the prevention and treatment of adverse respiratory sequelae.
authors.affiliation: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem. Electronic address: sorina@szmc.org.il.
authors.forename: Sorina
authors.initials: S
authors.lastname: Grisaru-Granovsky
authors.affiliation: Women & Children's Health Research Unit, Gertner Institute, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Brian
authors.initials: B
authors.lastname: Reichman
authors.affiliation: Women & Children's Health Research Unit, Gertner Institute, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.affiliation: Women & Children's Health Research Unit, Gertner Institute, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.affiliation: Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem.
authors.forename: Cathy
authors.initials: C
authors.lastname: Hammerman
authors.affiliation: Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem.
authors.forename: Arnon
authors.initials: A
authors.lastname: Samueloff
authors.affiliation: Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Schimmel
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007557:Israel; D008297:Male; D009017:Morbidity; D016017:Odds Ratio; D047928:Premature Birth / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Composite morbidity; Neonatal morbidity; Neonatal mortality; Trend; Very preterm and VLBW