title: The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain.
abstract: BACKGROUND
  Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease.
  
  
  OBJECTIVE
  To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011).
  
  
  METHODS
  This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants <230 or >346 weeks of gestational age (GA) were excluded.
  
  
  RESULTS
  During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of "outborn" patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001).
  
  
  CONCLUSIONS
  Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.
authors.affiliation: Division of Neonatology, CHUI Materno-Infantil, Las Palmas de Gran Canaria, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: García-Muñoz Rodrigo
authors.forename: Antonio
authors.initials: A
authors.lastname: Losada Martínez
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Elorza Fernández
authors.forename: Julio
authors.initials: J
authors.lastname: Moreno Hernando
authors.forename: Josep
authors.initials: J
authors.lastname: Figueras Aloy
authors.forename: Máximo
authors.initials: M
authors.lastname: Vento Torres
mesh_terms: D001724:Birth Weight; D045422:Continuous Positive Airway Pressure / Q000639:trends; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D063087:Noninvasive Ventilation / Q000639:trends; D010102:Oxygen Inhalation Therapy / Q000639:trends; D018743:Perinatal Care / Q000592:standards / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012120:Respiration Disorders / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012138:Respiratory Therapy / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013256:Steroids / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants; D013256:Steroids
keywords: Bronchopulmonary dysplasia; Databases; Morbidity; Newborn; Prematurity; Respiratory diseases