Very low gestational age infants in Estonia : measuring outcomes and insights into prognostic factors

Autorid: Toome L
Väljaandja/tellija: Tartu Ülikool. Lastekliinik
Märksõnad: sünnitus, enneaegne sünnitus, enneaegsed lapsed, puuetega lapsed
Välja antud: 2014
Avaldamise koht: Tartu
Tüüp: Doktoritöö
Nimi SuurusFormaat
Toome2014.pdf2.46 MBAdobe PDF
Kirjeldus: Advances in perinatal care have improved the survival of very preterm (VPT; born at <32 completed gestational weeks (GW) and/or with birth weight (BW) < 1500 g) infants dramatically (Fanaroff et al. 2003). However, survival and later neurological and developmental outcomes for these infants, especially for extremely preterm (EPT, born at < 28 GW and/or BW <1000 g) infants, remain of concern because of significant mortality and morbidity rates. About 1 to 1.5% of all births is at < 32 GW, but these infants account for one third to one half of all neonatal and infant deaths (EURO-PERISTAT Project 2010). Additionally they remain at substantial risk for a wide spectrum of long-term morbidities (Saigal and Doyle 2008), which leads to high emotional and economic costs for their families (van der Pal et al. 2007) and for society (Phibbs and Schmitt 2006, Korvenranta et al. 2010).
Providing quality care is a core principal of modern healthcare. Advances in perinatal care of VPT infants have resulted in improvements in gestation-specific survival rates such that, in the developed countries as well as in Estonia, mortality is no longer a particularly useful measurement of quality of care. If the aim of neonatal care is to achieve long-term survival free of handicap, then it is mandatory that any assessment of the quality of care for VPT infants must include the long-term outcome for these in fants. It is important to document the long-term outcomes of survivors of VPT births and to link this to events within the perinatal period. In general, 2 years corrected for gestational age (GA) at birth is considered an acceptable time for collecting initial follow-up data about VPT infants. At this age, it is likely that the findings will still be relevant to current clinical practice, and the effects of social and demographic factors are minimised (Lyon 2007). Healthcare and healthsystem factors also play a role in outcome for VPT infants more generally. For VPT births, delivery in a tertiary level maternity unit with an onsite tertiary level neonatal intensive care is associated with lower mortality (Poets et al. 2004, Marlow et al. 2014). It has also been shown that long-term health outcomes for EPT infants are better if they receive their whole initial neonatal care in tertiary level units (Rautava et al. 2013).
Population-based study designs and standardised data collection have been recommended for the evaluation of perinatal care services, as well as for studies of prognosis (Evans and Levene 2001, Marlow 2003). Since the introduction of antenatal steroids and postnatal surfactant therapy in perinatal treatment of VPT infants, studies from developed countries have presented population-based as well as nationwide short-term and long-term outcomes for VPT and EPT infants. However, although some data are available, no nationwide studies have been published that relate to Eastern European countries, which have more limited resources and less experience in the care of EPT infants than the developed countries.
In Estonia, the only previously published data with respect to the outcome of VPT infants are for infants with a BW less than 1500 g born in 1999-2000 at the infants' age of 3 years (Ormisson et al. 2009). Therefore, the studies of the present thesis were undertaken with the primary objectives to, first, describe the
short-term and long-term outcome for VPT infants in Estonia after introduction of modern perinatal and neonatal care, and second, to benchmark altogether the quality of healthcare services for these vulnerable infants in Estonia and to identify key areas for ongoing national quality improvement initiatives.