Short Term Mortality and Morbidity in Extremely Preterm Babies Born before 27 Gestational Weeks: Comparison between Two Birth Cohorts (1999-2003 and 2010-2016) in a Belgian Third Level NICU

Abstract

Purpose
To compare mortality and morbidity in a third-level neonatal intensive care unit in 2010-2016 in order to assess changes in outcomes since 1999-2003 and to evaluate possible intervention improvement.

Methods
We retrospectively analyzed data collected between 2010 and 2016 on 109 patients born before 27 gestational weeks among infants hospitalized at the Cliniques Universitaires Saint Luc in Brussels. We compared them with a previous internal study cohort of 75 patients of the same age born between 1999 and 2003. We compared mortality and morbidity at unit discharge between the two periods.

Results
The overall mortality rate of extremely preterm infants decreased by 4% from 1999-2003 to 2010-2016. This is not statistically significant (p=0,66). Neonatal deaths occurred earlier in the period 1999-2003. Between 1999 and 2003 deaths were most often attributed to multiorgan failure. In the 2010-2016 period deaths were most frequently attributed to severe central nervous system injury.  
The overall prevalence of survivors without major morbidities decreased by 2% from the 1999-2003 to the 2010-2016 period (p=0,78), also not statistically significant.

Conclusions
Our findings corroborate previous studies suggesting that improved outcomes for infants born before 25 weeks of gestation might be achieved by considering resuscitation before 24 weeks. In order to obtain more statistically significant data, future research should compare the Belgian EPIBEL 1999-2000 cohort with a more recent Belgian cohort, potentially clarifying the impact of advanced interventions and care strategies on mortality and morbidity rates in extremely preterm infants.