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Original Paper

Changes in Perinatal Care and Outcomes in Newborns at the Limit of Viability in Spain: The EPI-SEN Study

García-Muñoz Rodrigo F.a · Díez Recinos A.L.a · García-Alix Pérez A.b · Figueras Aloy J.c · Vento Torres M.d · and the SEN1500 Network of the Spanish Neonatal Society (Sociedad Española de Neonatología)

Author affiliations

aDivision of Neonatology, Complejo Hospitalario Universitario Insular-Materno-Infantil, Las Palmas, bDivision of Neonatology, Hospital Sant Joan de Deu, and cDivision of Neonatology, Hospital Clinic, Barcelona, and dDivision of Neonatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain

Related Articles for ""

Neonatology 2015;107:120-129

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 15, 2014
Accepted: October 02, 2014
Published online: December 10, 2014
Issue release date: February 2015

Number of Print Pages: 10
Number of Figures: 1
Number of Tables: 5

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: http://www.karger.com/NEO

Abstract

Background: Advances in perinatal care can influence morbidity and mortality in newborns at the limit of viability. Knowledge of these changes over time may help improve clinical decision making, optimize resource allocation and increase quality of care. Objectives: To evaluate the influence on morbidity and mortality of changes introduced in the perinatal care of preterm infants (22-26 weeks' gestational age, GA) in Spain between two consecutive periods (2002-2006 and 2007-2011). Methods: An analysis of prospectively collected data in a national database network (SEN1500) was performed. All live newborn infants of 22-26 weeks' GA born in or transferred to referral centers of the SEN1500 network in the first 28 days of life were included. Perinatal interventions, clinical management, neonatal morbidity, and survival until hospital discharge were retrieved. Results: A total of 5,470 newborns were included (2,533 and 2,937 in each period, respectively). The major changes introduced during the second period were as follows: (1) lower proportion of extramural births (11.0 vs. 8.9%, p = 0.01), (2) increase in antenatal steroids (69.5 vs. 80.8%, p < 0.001), (3) delivery by C-section (41.8 vs. 48.3%, p < 0.001) and (4) use of CPAP during resuscitation (7.8 vs. 20.7%, p < 0.001). Death in the delivery room decreased from 5.1 to 3.2% (p < 0.001). Survival increased from 49.9 to 57.9% (p < 0.001), and survival without major morbidity increased from 18.1 to 21.2% (p = 0.006). Conclusions: During the second period, a greater attachment to practices proven to have a beneficial impact on survival and reduction of morbidity in the extremely preterm infant was noted, and survival and survival without major morbidity increased. A more conservative approach was detected for newborns of 22 weeks' GA.

© 2014 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 15, 2014
Accepted: October 02, 2014
Published online: December 10, 2014
Issue release date: February 2015

Number of Print Pages: 10
Number of Figures: 1
Number of Tables: 5

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: http://www.karger.com/NEO


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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