Decreases in infant morbidity, mortality slowed in recent years
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Key takeaways:
- In the last decade, rates of morbidity and mortality continued to decrease for very preterm infants, but at a slower pace than before.
- The rate of chronic lung disease has increased since 2012.
Rates of morbidity and mortality among very preterm infants in the United States have continued to decrease but at a slower pace in recent years, and the rate of chronic lung disease has increased, according to study findings.
“We regularly do trends analyses — this time it was prompted by a manuscript from the Neonatal Research Network sponsored by NIH, which also published an analysis of a long time series,” Erika M. Edwards, PhD, MPH, director of data science at the Vermont Oxford Network and co-author of the study, told Healio.
“This manuscript uses the same methodology as the National Cancer Institute for trend analyses,” Edwards said of the new study. “The method identifies time points of change in a trend by identifying them empirically.”
In total, 888 member hospitals of the Vermont Oxford Network contributed data on 447,396 infants born between 24 and 28 weeks’ gestation from 1997 to 2021.
Edwards and colleagues reported data on mortality, late-onset sepsis, necrotizing enterocolitis, chronic lung disease, severe intraventricular hemorrhage, severe retinopathy of prematurity and death or morbidity by year of birth, including risk-adjusted annual percentage changes with 95% confidence intervals overall and by gestational age week.
According to their analysis, from 1997 to 2021, mortality among these infants decreased from 18.1% to 12.4%, late-onset sepsis from 34.2% to 13.4%, necrotizing enterocolitis from 10% to 6.8%, severe intraventricular hemorrhage from 11.8% to 10.7% and severe retinopathy of prematurity from 14.8% to 9.3%.
Overall, the rate of death or morbidity decreased from 65.4% to 57.6%, but the rate of chronic lung disease increased from 33.4% to 43.4%.
The rate of mortality was stable from 1997 to 2005, decreased from 2005 to 2012, then decreased at a slower rate from 2012 to 2021. Similarly, the rate of late-onset sepsis decreased more slowly after 2012, whereas the rate of severe retinopathy of prematurity decreased more slowly after 2011 and the rates of three other outcomes — necrotizing enterocolitis, severe intraventricular hemorrhage and death or morbidity — remained stable after 2015, the researchers reported.
“We were surprised by how many years the software identified trends that had been the same,” Edwards said.
Future research will look at care and interventions for the same population during the same time period and infants born at younger gestational ages, Edwards said.
“We concluded that perhaps the things that we have been doing are not working as well as they did previously,” Edwards said. “We suggested that we need to focus on research to develop new therapies; quality improvement; and follow through, or a commitment to address health-related social needs.”
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