Death or survival with major morbidity in VLBW infants born at Brazilian neonatal research network centers

Abstract

Objective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.

Methods: Prospective cohort of 2646 inborn infants with gestational age 23–33 weeks and birth weight 400–1499 g, without malformations, born at 20 centers in 2012–2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with ≥1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3–4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).

Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3–4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55–0.88), C-section (0.72; 0.58–0.90), gestational age <30 (4.00; 3.16–5.07), being male (1.44; 1.19–1.75), small for gestational age (2.19; 1.72–2.78), 5th-min Apgar <7 (3.89; 2.88–5.26), temperature at NICU admission <36.0 °C (1.42; 1.15–1.76), respiratory distress syndrome (3.87; 2.99–5.01), proven late sepsis (1.33; 1.05–1.69), necrotizing enterocolitis (3.10; 2.09–4.60) and patent ductus arteriosus (1.69; 1.37–2.09).

Conclusions: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.

• Bronchopulmonary dysplasia
• intraventricular hemorrhage
• neonatal mortality
• periventricular leukomalacia
• preterm newborn infant
• retinopathy of prematurity
• very low birth weight newborn infant

Acknowledgements

We thank Olga Bomfim, MD, Cynthia Magluta, MD, PhD, and Francisco E. Martinez, MD, PhD, for helping with the administration of Brazilian Network on Neonatal Research.

Declaration of interest

BRAZILIAN NETWORK ON NEONATAL RESEARCH (Rede Brasileira de Pesquisas Neonatais RBPN). Health Ministry of Brazil (Ministério da Saúde do Brasil (MS/VIGISUS 1755/2000; MS/FNS 274; FIOCRUZ/PDTSP) funded this study. The authors declare no conflicts of interest. Ruth Guinsburg and Maria Fernanda Branco de Almeida conceptualized and designed the study, carried out all study’s analyses, drafted the initial article, reviewed and revised the article, and approved the final article as submitted. Ana Lucia Acquesta, Cristina Nunes Dos Santos, Dulce Maria Toledo Zanardi, Edna Maria De Albuquerque Diniz, Humberto Holmer Fiori, Jamil Pedro de Siqueira Caldas, José Luiz Bandeira Duarte, Jucille do Amaral Meneses, Junia Sampel de Castro, Laura Emilia Monteiro Bigélli Cardoso, Lígia S. Lopes Ferrari, Maria Albertina Santiago Rego, Maria Elisabeth Moreira, Maria Regina Bentlin, Marynéa Silva do Vale, Navantino Alves Filho, Paulyne Stadler Venzon, Rita C. Silveira, Vânia Olivetti Steffen Abdallah, and Walusa Assad Gonçalves Ferri: helped to design and plan the study, coordinated and supervised data collection at each site, critically reviewed the article, and approved the final article as submitted.