Assessment and comparison of the mortality and morbidityrates of very low birth weight (VLBW) infants followedbetween years 2014-2018 in Dokuz Eylül University Faculty ofmedicine neonatal intensive care unit with previous results

Introduction and Purpose:Due to developments in perinatal and neonatal care, the survival rates of premature infants increased globally, but the morbidity and chronic disease rates of very low birth weight infants also increased. The aim of this study is to indicate the neonatal results of very low birth weight infants followed during the last five years in Dokuz Eylul Universit Neonatal Intensive Care Unit including their morbidities, birth weights, gestational age related mortalities and care applications; and to compare these results with the results of our previous study which analyzed the results between years 1996 and 2000 and also to compare our results with nationwide data and with data from developed countries. Thus, evaluation of our current applications and determination of areas which require develpment were intended. Study Format: Retrospective sectional study Patients and Method: Infants born in Dokuz Eylul University Faculty of Medicine between dates 01.01.2014 and 31.12.2018 and followed in the Neonatal Intensive Care Unit until discharge (or mortality) and infants born in another unit and referred to our unit within his/her first day and completed his/her follow-up in our unit were included in the study. Infants referred to another unit without completing follow-ups and infants with major congenital anomalies were excluded. Preeclampsia, chorioamnionitis, presence of early membrane rupture (EMR), application of antenatal steroids, singularity / plurality of pregnancy were recorded as maternal properties of the infants included in the study. Gestational age, birth weight, Apgar score, presence of resuscitation in the delivery room, duration of invasive and non-invasive mechanical ventilation throughout stay in hospital, duration of oxygen treatment, duration of total parenteral nutrition, presence of air leakage syndrome, duration of hospital stay, weight at discharge were recorded as demographic and clinical properties of infants in the study. All mortality and major morbidity data (RDS, BPD, ROP, PDA, NEC, IVH, PVL) were recorded. All data were obtained from patient files and electronic data, and notes in these data were re-evaluated with consecutive measurements, examination notes and laboratory results. Results: 203 infants were included in the study. The mean birthweight was found to be 976gr (400- 1500 gr) and mean gestational age was recorded as 27.8 weeks (22-32 weeks). The distribution of birhweight and gestational age of the infants indicated that 26.1% of the infants were between 501- 750 gr and 45.3% of the were between 28-31 weeks. Antenatal steroid was applied to 69% of the pregnants. The rate of Caesarean section was determined as 83.3%. 53.7% of the infants were diagnosed with RDS, air leakage syndrome was seen in 23 infants (11.3%), and hemodynamically significant PDA was seen in 60 infants (31.9%). The rates of some conditions was determined as follows: severe IVH (>Stage 2) 5.6%, PVL 8.3%, intermediate-severe BPD 20.6%, ROP (>Stage 2) 2.4%, NEC (>Stage 2) 2.9%, early sepsis 6.8%,and late sepsis 39.6%. The mean duration of hospitalization was determined as 53.4±24.3 days in survivors, and 9.9±15.5 days in mortal patients. The total rate of mortality till discharge was found to be 23.6%. Survival rate of infants with birthweights <501gr was 16.7% , the same rate was found to be %49.1 for infants with birthweights between 501-750gr, 82% for infants with birthweights between 751-1000gr, 93.5% for infants with birthweights between 1001-1250gr, and 91.7% for infants with birthweights between 1251-1500gr. Mortality rate of males was found to be higher in male patients than female patients (30% and 17% respectively). Whencomparing these results with the similar study evaluating data from our unit between years 1996 and 2000; it was seen that in the last study, the average birth weights and gestational ages of infants were lower. Also, when analyzing the distribution of birth weights and gestational ages, it was significantly clear that in the last study, small infants were more in number and big infants were less in number. When comparing other demographic and natal properties, in the last group, application of antenatal steroids, rate of SGA, need of endotracheal intubation in the delivery room, rate of infants with an APGAR score of <6 in the fifth minute were higher and these results were statistically significant. Multiparity rates, form of birth and gender were similar among two groups. When the postnatal clinical properties of the two groups were compared, the infants with RDS, infants applied surfactant and infants that received ventilator support were higher in number in the last group. The duration of ventilator support and the duration of hospital stay among survivors were longer in the last group. Air leakage syndrome was seen more in the last group; and though the rates of survival were similar, the rate of survival without any major morbidiy was smaller in the last group. Growth retardation in discharge, duration of TPN and duration of hospital stay among mortal patiens were similar in two groups. When comparing majör morbidity data of the two groups, it was seen that the rates of bronchopulmonary dysplasia and NEC ( >Stage 2) were higher in the last group, while the rates of ROP ( >Stage 2), IVH ( >Stage 2) and PVL were similar among the two groups. When comparing the mortality data with birth weights and gestational age, lower mortality rates were seen among infants in the last group, however this was not statistically significant. Conclusion:Comparing data from 1996-2000 with data from 2014-2018, it was understood that more and more risky infants were given care in our country. Given that infants with less birth weight and smaller gestational age were followed recently; rates of survival stayed the same, and the rates of BPD and NEC as major morbidites were higher. Nevertheless, these rates were observed as similar or lower when comparing these rates with nationwide data and data from developed countries.