Low birth weight infants have better outcomes in Swiss neonatal units
Very low birth weight infants born within Swiss neonatal care units are more likely to have better outcomes when compared with infants born in American units, including the risk of death or major morbidity, according to findings published in Pediatrics.
“Very low birth weight infants born in U.S. units participating in the Vermont Oxford Network [VON] have a significantly lower risk for delivery room mortality than infants born in units of the Swiss Neonatal Network [SNN],” Mark Adams, MSc, from the department of neonatology at University Hospital Zurich, told Infectious Diseases in Children.
“This is largely because most of the infants born in the SNN below 24 weeks’ gestation received a priori comfort care. US-VON units also have a significantly higher risk for necrotizing enterocolitis, chronic lung disease and retinopathy of prematurity,” he continued. “These differences remain even if the comparison is restricted to a cohort with the same delivery room mortality and is independent of survival bias.”
To compare neonatal outcomes and the practices that neonatal health care providers use, Adams and colleagues conducted a retrospective observational study that encompassed all live-born infants born in the SNN and the US-VON who were of very low birth weight (501-1,500 g). Neonates that were included in the study were registered by one of the two networks between 2012 and 2014 within 696 US-VON units and 13 SNN units.
The researchers also conducted an analysis of neonatal outcomes using a multivariable and propensity score-matched approach, which accounted for case-mix, race, prenatal care administered and unit-level factors. Adams and colleagues then indirectly compared these outcomes with infants who received standardized practices.
Of the infants born within the 696 US-VON units, 123,689 were born alive. In comparison, 2,209 infants were born alive in the 13 SNN units included in the analysis. The researchers observed a lower risk of death or major morbidity in SNN units (adjusted RR: 0.56; 95% CI, 0.51-0.62), as well as in all other outcomes, excluding mortality outcomes. Adams and colleagues observed a greater risk of this outcome in SNN units (aRR: 1.28; 95% CI, 1.09-1.50).
According to the researchers, both networks regularly use intensive care for very low birth weight neonates. When they matched propensity scores and analyzed only infants who had no expectation of survival, Adams and colleagues observed comparable risks in the outcomes assessed. The researchers also observed that units included in the SNN were more likely to use more antenatal steroids, less invasive interventions within the delivery room and less intrusive respiratory support.
“These differences in outcome remain after adjusting for perinatal, neonatal and infrastructure parameters,” Adams said. “SNN units appear to follow established evidence closer for some of the observed practices, such as using less invasive respiratory support in the delivery room. We are currently investigating whether such practice differences can directly be associated to outcome. If so, I believe we will have great opportunities to learn from each other within and between networks.” – by Katherine Bortz
Disclosures: Adams reports receiving a salary as network coordinator for the Swiss Neonatal Network. Please see the study for a full list of other authors’ relevant financial disclosures.