Declines in neonatal mortality have been attributed to neonatal intensive care.
An alternative to the « better care » hypothesis is the « better babies » hypothesis ; ie, very low birth weight infants are delivered less ill and therefore have better survival.
We ascertained outcomes of all live births<1500 g in two prospective inception cohorts.
We estimated mortality risk from birth weight and illness severity on admission and measured therapeutic intensity.
We calculated logistic regression models to estimate the changing odds of mortality between cohorts.
Two cohorts in the same two hospitals, 5 years apart (1989-1990 and 1994-1995) (total n=739).
Neonatal intensive care unit mortality declined from 17.1% to 9.5%, and total mortality declined from 31.6% to 18.4%. Cohort 2 had lower risk (higher birth weight, gestational age, and Apgar scores and lower admission illness severity for newborns >=750 g).
Risk-adjusted mortality declined (odds ratio, 0.52 ; confidence interval, 0.29-0.96).
One third of the decline was attributable to « better babies » and two thirds to « better care. » Use of surfactant, mechanical ventilation, and pressors became more aggressive, but decreases in monitoring, procedures, and transfusions resulted in little change in therapeutic intensity.
Mortality decreased nearly 50% for infants<1500 g in 5 years. (...)
Mots-clés Pascal : Mortalité, Poids naissance très faible, Nourrisson, Homme, Etude cohorte, Efficacité traitement, Soin intensif, Technique obstétricale, Tocolytique, Césarienne, Pronostic, Prématuré, Gestation pathologie, Nouveau né pathologie, Réanimation, Accouchement pathologie
Mots-clés Pascal anglais : Mortality, Very low birthweight, Infant, Human, Cohort study, Treatment efficiency, Intensive care, Obstetrical technique, Tocolytic, Cesarean section, Prognosis, Premature, Pregnancy disorders, Newborn diseases, Resuscitation, Delivery disorders
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0510637
Code Inist : 002B20F02. Création : 23/03/1999.