The NICHD neonatal research network: changes in practice and outcomes during the first 15 years
Section snippets
Methods
Since its inception, NICHD Neonatal Research Network maintained a very low birth weight (VLBW) registry incorporating perinatal and neonatal data on all infants with a birth weight less than 1500 g cared for at participating centers. In the registry, maternal and infant data are collected by using common definitions developed by the investigators, and described in the study Manual of Operations and in previous publications.1, 2, 3, 4, 5 This database has examined factors contributing to
Results
Selected perinatal parameters are presented for the total population in Table 1 and by birth weight categories in Table 2.
Antenatal corticosteroid use increased from 16% in 1987/1988 to 79% in 1999/2000 and maternal antibiotic administration increased from 42% to 70% (P <. 01) between 1993/1994 and 1999/2000 (Table 1). Since the inception of the Network, multiple births have increased from 18% to 26% and deliveries by cesarean section have increased from 47% to 57%. However, the need for
Discussion
We have documented the changes in mortality and major morbidities during the first 15 years of the Network. Noticeable improvements in mortality were documented after the introduction of surfactant therapy to the Network centers in 1990. Remarkably, all network centers were naı̈ve to surfactant so that its impact could be measured. Horbar et al6 was able to show a decline in mortality from 28% to 20% for infants with birth weights 601–1300 g after the widespread availability and utilization of
Conclusion
Over the course of the Network, we have documented a significant improvement in the survival of infants with birth weights between 501 and 1500 g. These can be attributed to a combination of factors, including improved technology and better understanding of the patho-physiology of disease in these low birth weight infants. Surfactant therapy and increased utilization of antenatal corticosteroids have also played a role. However, there have been no substantial improvements in outcomes over the
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