title: In-hospital morbidity and brain metrics of preterm neonates born 1998-2009.
abstract: OBJECTIVE
  To describe the survival, in-hospital morbidity, brain metrics and two-year neurodevelopmental outcomes of two extremely preterm cohorts and discuss the contribution of changes in clinical practice to these outcomes.
  
  
  METHODS
  Retrospective comparative cohort study, of two cohorts of neonates born <28 weeks gestation: 47 infants born 1998-2000 and 39 infants 2006-2009.
  
  
  RESULTS
  Comparing historical to the contemporary cohort respectively, admission temperature (35.9 degrees C, 36.5) and CRIB (Clinical Risk Index in Babies) score (5.4, 3.1) improved. Inotrope support fell significantly (55.3%, 28.2%). High frequency ventilation days fell (8.0, 2.7). CPAP days increased significantly (32.2, 47.9). Chronic lung disease at 36 weeks corrected age fell significantly (61.7%, 38.5%). Red cell transfusions decreased in number (7.1, 4.8) and volume (96.2ml/kg, 70.4ml/kg). Retinopathy of prematurity (ROP) rates dropped significantly (66.0%, 28.2%). Survival was not significantly different. Nutritional improvements included shorter days to first enteral feed (3.4, 2.0), target protein (5.4, 4.3) and lipid levels (7.1, 4.1) with better breastfeeding rates at discharge (19.2%, 38.5%). By 36 weeks z scores for weight (-0.90, -0.39) were improved but not length (-1.94, -1.26) or head circumference (-0.72, -0.69). MRI brain metrics showed a significant improvement in bifrontal (59.2, 65.9), biparietal (73.7, 79.3) and transcerebellar diameter (50.6, 52.6) with improved neurodevelopmental outcome at two years.
  
  
  CONCLUSIONS
  The contemporary cohort had better initial physiological stability, less chronic lung disease and retinopathy, improved body growth at 36 weeks and brain metrics at term equivalent. Improvement in neurodevelopment at two years has been seen and further analysis will be important to understand the impact of the changes in clinical care.
authors.affiliation: Neonatologist, Neonatal Service, Christchurch Women's Hospital, Department of Pediatrics, University of Otago, Christchurch.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Harris
authors.affiliation: Neonatologist, Associate Professor, Neonatal Service, Christchurch Women's Hospital, Department of Pediatrics, University of Otago, Christchurch.
authors.forename: Nicola C
authors.initials: NC
authors.lastname: Austin
authors.affiliation: Neonatologist, Newborn Services, Auckland City Hospital, Auckland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Battin
authors.affiliation: Neonatologist, Dunedin Neonatal Unit, Dunedin.
authors.forename: Roland
authors.initials: R
authors.lastname: Broadbent
authors.affiliation: Statistician, Associate Professor, Department of Psychological Medicine, University of Otago, Christchurch.
authors.forename: John
authors.initials: J
authors.lastname: Horwood
authors.affiliation: Neuroradiologist, Canterbury Radiology Group, Christchurch.
authors.forename: Ross
authors.initials: R
authors.lastname: Keenan
authors.affiliation: Neuroradiologist, Canterbury Radiology Group, Christchurch.
authors.forename: Scott
authors.initials: S
authors.lastname: Wells
authors.affiliation: Research Nurse, Neonatal Service, Christchurch Women's Hospital, Christchurch.
authors.forename: Carole
authors.initials: C
authors.lastname: Spencer
authors.affiliation: Research Nurse, Neonatal Service, Christchurch Women's Hospital, Department of Pediatrics, University of Otago, Christchurch.
authors.forename: Patricia
authors.initials: P
authors.lastname: Graham
authors.affiliation: Professor of Pediatrics and Psychology, Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, US.
authors.forename: Lianne J
authors.initials: LJ
authors.lastname: Woodward
authors.affiliation: Neonatologist, Professor, Neonatal Service, Christchurch Women's Hospital, Department of Pediatrics, University of Otago, Christchurch.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Darlow
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D001942:Breast Feeding; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D008171:Lung Diseases / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009017:Morbidity; D009520:New Zealand; D012178:Retinopathy of Prematurity / Q000453:epidemiology*; D012189:Retrospective Studies