Preterm Infants’ Follow-Up Program at a Public Hospital in Buenos Aires: Two-Decade Study
DOI:
https://doi.org/10.6000/2292-2598.2014.02.02.8Keywords:
Preterm, growth, morbidity, mortality, neurodevelopment.Abstract
Objectives: To analyze temporal trends of mortality, morbidity, growth and neurodevelopment until 2 years of corrected age (CA) of very low birth weight infants (VLBWI) born between 1986- 2005 in Ramon Sardá Maternal Infant Hospital (RSMIH).
Methods: Descriptive temporal trend study divided in 5 quinquenniums. 1255 VLBWI were born at RSMIH between 1986-2005; 46 were excluded (genetic syndromes, major congenital malformations, confirmed intrauterine infections), 84 were referred out and 1125 were studied. Birth weight (BW), gestational age (GA); morbidity; growth; neurodevelopment at 1 and 2 years of CA; neurological and sensorial disorders, antenatal steroids use, breastfeeding; rehospitalizations; mothers´ age and years of schooling and Unsatisfied Basic Needs Index (UBNI) were recorded.
Results: Survival rates increased during the last two periods, especially in <1000g BW infants despite the decrease in GA and BW. Children receiving surfactant (Sf), parenteral nutrition (PN) and antenatal steroids (AS) in the last quinquennium obtained better results in growth (40 weeks GA and 1 CA). The use of these therapies increased greatly in the last decade. Also breastfeeding at 40 weeks GA and 4 months tended to be better. Bronchopulmonary dysplasia (BPD) increased. Rehospitalizations (majorly attributable to lower tract infections) and UBNI stayed equal all along. Mothers’ years of schooling increased a little in the last two quinquenniums.
Conclusion: In the last quinquennium children tended to be smaller in GA and BW due to an increase in the survival rate as a result of higher technology and appropriate interventions such as AS, PN, Sf, etc.
References
Blencowe H, Lee AC, Cousens S, et al. Preterm birth–associated neurodevelopmental impairment estimates at regional and global levels for 2010. Pediatr Res 2013; 74: 17-34. http://dx.doi.org/10.1038/pr.2013.204 DOI: https://doi.org/10.1038/pr.2013.204
Schlapbach LJ, Adams M, Proietti H, et al. Swiss Neonatal Network & Follow-up Group. Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008. BMC Pediatr 2012; 12: 198. http://dx.doi.org/10.1186/1471-2431-12-198 DOI: https://doi.org/10.1186/1471-2431-12-198
DEIS. Programa Nacional de Estadísticas de Salud. Estadísticas Vitales. Información Básica-2007. Ministerio de Salu. 2008 [cited 2014 May 2]; 5(51). Available from: http://www.bvs.org.ar/pdf/anuario07.pdf
Gupta S, Prasanth K, Chen CM, Yeh TF. Postnatal corticosteroids for prevention and treatment of chronic lung disease in the preterm newborn. Int J Pediatr 2012; 2012: 315642. Available from: Academic Search Premier, Ipswich, MA. DOI: https://doi.org/10.1155/2012/315642
Vohr BR, Wright LL, Dusick AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics 2000; 105: 1216-26. http://dx.doi.org/10.1542/peds.105.6.1216 DOI: https://doi.org/10.1542/peds.105.6.1216
Sarrasqueta P. Mortalidad infantil por malformaciones congénitas y prematurez en la Argentina: análisis de los criterios de reducibilidad. Arch Argent Pediatr 2006; 104: 153-8.
Bahíllo Curieses MP, Fernández Calvo J, Mora Cepeda P. Corticoides antenatales en la amenaza de parto prematuro. Bol Pediatr 2003; 43: 267-71.
El-Gendy N, Kaviratna A, Berkland C, Dhar P. Delivery and performance of surfactant replacement therapies to treat pulmonary disorders. Ther Deliv 2013; 4: 951-80. http://dx.doi.org/10.4155/tde.13.72 DOI: https://doi.org/10.4155/tde.13.72
Ziegler EE, Thureen PJ, Carlsson SJ. Aggressive nutrition of very low birth weight infant. Clin Perinatol 2002; 29: 225-44. http://dx.doi.org/10.1016/S0095-5108(02)00007-6 DOI: https://doi.org/10.1016/S0095-5108(02)00007-6
González MA, Enríquez D, Larguía AM. Contacto piel a piel madre/hijo prematuro. Conocimientos y dificultades para su implementación. Rev Hosp Mat Inf Ramón Sardá 2006; 254: 159-66.
Nieto R, Solanas C, Oviedo A, et al. Participación de las madres en el cuidado de los recién nacidos internados en un servicio de neonatología que aplica el modelo de maternidad centrada en la Familia. Rev Hosp Mat Inf Ramón Sardá 2011; 30: 146-50.
Norman JE, Morris C, Chalmers T. The effect of changing patterns of obstetric care in Scotland (1980–2004) on rates of preterm birth and its neonatal consequences: perinatal database study. Plos Med 2009; 6: e1000153. http://dx.doi.org/10.1371/journal.pmed.1000153 DOI: https://doi.org/10.1371/journal.pmed.1000153
Laterra C, Luchtenberg G, Grandi C, Pensotti A. Estadísticas hospital Materno Infantil "Ramón Sardá". Rev Hosp Mat Inf Ramón Sardá 2008; 27: 162-5.
Ralser E, Mueller W, Haberland C, et al. Rehospitalization in the first 2 years of life in children born preterm. Acta Paediatr 2012; 101: e1-5. DOI: https://doi.org/10.1111/j.1651-2227.2011.02404.x
Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M. Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013; 13 (Suppl 1): S10. doi: 10.1186/1471-2393-13-S1-S10. DOI: https://doi.org/10.1186/1471-2393-13-S1-S10
Schapira I. Desarrollo infantil: intervención oportuna y adecuada. PRONAP. Bs As.: SAP, 2009.
Vohr BR, O´Shea M, Wright LL. Longitudinal multicenter follow-up of high-risk infants: why, who, when, and what to assess. Sem Perinat 2003; 27: 333-42. http://dx.doi.org/10.1016/S0146-0005(03)00045-4 DOI: https://doi.org/10.1016/S0146-0005(03)00045-4
Larguía M, Schapira I, Aspres N, y cols. Guía para padres de prematuros del Hospital Sardá. Bs. As.: FN, 2009.
Comité Nacional de Crecimiento y Desarrollo. La Sociedad Argentina de Pediatría actualiza las curvas de crecimiento de niñas y niños menores de 5 años. Arch Argent Pediatr 2008; 106: 462-7.
Rodríguez S, Arancibia V, Undurraga C. Escala de evaluación del desarrollo psicomotor: 0-24 meses. Santiago de Chile: Ed. Galdoc Ltda, 1998.
Bobath B, Bobath K. Desarrollo motor en distintos tipos de parálisis cerebral. Bs. As.: Ed. Panamericana, 1987; pp. 111-23.
Feres JC, Mancero X. El método de las necesidades básicas insatisfechas (NBI) y sus aplicaciones en América Latina. Bs. As.: CEPAL-UN, 2001.
Morbi-Mortalidad Materna y Mortalidad Infantil en la República Argentina Estrategias para mejorar el desempeño de los Servicios de Salud Materno Infantil. Bs. As.: Min Sal, 2004. [cited 2014 May 15] Available from: www.msal.gov.ar/ htm/Site/promin/USMISALUD/publicacines/pdf/morbimor.pdf
Fanaroff A, Hack M, Walsh M .The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Sem Perinat 2003; 27: 281-7. http://dx.doi.org/10.1016/S0146-0005(03)00055-7 DOI: https://doi.org/10.1016/S0146-0005(03)00055-7
Arce Casas A, Iriondo Sanz M, Krauel Vidal J, et al. Seguimiento neurológico de recién nacidos menores de 1.500 gramos a los dos años de edad. Ann Pediatr 2003; 59: 454-61. http://dx.doi.org/10.1016/S1695-4033(03)78760-8 DOI: https://doi.org/10.1157/13053368
Rogowski JA, Staiger DO, Horbar JD. Variations in the quality of care for very low birth weight infants: implications for policy. Health 2004; 23: 88-97. DOI: https://doi.org/10.1377/hlthaff.23.5.88
Bancalari E. Factores perinatales en el pronóstico del prematuro extremo. Arch Pediatr Urug 2003; 74: 158-65.
Crowley P. Antenatal corticosteroids-current thinking. Br J Obstet Gynaecol 2003; 1110: 77-8. DOI: https://doi.org/10.1016/S1470-0328(03)00041-7
Stoelhorst G, Rijken M, Shirley E, et al. Leiden Follow-Up Project on Prematurity. Changes in neonatology: comparison of two cohorts of very preterm infants (gestational age < 32 weeks): the Project on Preterm and Small for Gestational Age Infants 1983 and the Leiden Follow-up Project on Prematurity 1996-1997. Pediatrics 2005; 115: 396-405. http://dx.doi.org/10.1542/peds.2004-1497 DOI: https://doi.org/10.1542/peds.2004-1497
Tapia JL, Quezada M, Gederlini A, et al. NEOCOSUR: Informe anual 2008. Rev Hosp Mat Inf Ramón Sardá 2008; 27: 166-79.
Dinerstein A, Nieto RM, Solana CL, Perez GP, Otheguy LE, Larguía AM. Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinat 2006; 26: 436-42. http://dx.doi.org/10.1038/sj.jp.7211539 DOI: https://doi.org/10.1038/sj.jp.7211539
Novali L. Evolución alejada del recién nacido prematuro con hemorragia intracraneana y leucomalacia periventricular. PRONEO. Bs. As.: Ed Panamericana, 2001.
Bode MM, D'Eugenio DB, Forsyth N, Coleman J, Gross CR, Gross SJ. Outcome of extreme prematurity: a prospective
comparison of 2 regional cohorts born 20 years apart. Pediatrics 2009; 124: 866-74. http://dx.doi.org/10.1542/peds.2008-1669 DOI: https://doi.org/10.1542/peds.2008-1669
Salvia A, Quartulli D. La movilidad y la estratificación socio-ocupacional en la Argentina. Un análisis de las desigualdades de origen. Rev Soc 2012; 2: 15-42.
Kugelman A, Reichman B, Chistyakov I, et al. Postdischarge infant mortality among very low birth weight infants: a population-based study. Pediatrics 2007; 120: e788-94. DOI: https://doi.org/10.1542/peds.2006-3765
Hayakawa LM, Schmidt KT, Rossetto EG, Souza SN, Bengozi TM. Incidência de reinternação de prematuros com muito baixo peso nascidos em um hospital universitário. Esc Anna Nery Rev Enferm 2010; 14: 324-9. http://dx.doi.org/10.1590/S1414-81452010000200016 DOI: https://doi.org/10.1590/S1414-81452010000200016
Eidelman AI, Schanler RJ, Johnston M, et al. Breastfeeding and the use of human milk. Pediatrics 2012; 129: e827-41. http://dx.doi.org/10.1542/peds.2011-3552 DOI: https://doi.org/10.1542/peds.2011-3552
Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999; 70: 525-35. DOI: https://doi.org/10.1093/ajcn/70.4.525
Hack M, Breslau N. Very low birth weight infants: effects of brain growth during infancy on intelligence quotient at 3 years of age. Pediatrics 1986; 77: 196-202. DOI: https://doi.org/10.1542/peds.77.2.196
de Carlos Castresana Y, Castro Laiz C, Centeno Monterrubio C, Martin Vargas L, Cotero Lavin A, Valls i Soler A. Postnatal growth up to 2 years of corrected age in a cohort of very low birth weight infants. An Pediatr (Barc) 2005; 62: 312-9. http://dx.doi.org/10.1157/13073243 DOI: https://doi.org/10.1157/13073243
Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003; 111: 986-90. http://dx.doi.org/10.1542/peds.111.5.986 DOI: https://doi.org/10.1542/peds.111.5.986
Cheong JL, Hunt RW, Anderson PJ, Howard K, Thompson DK, Wang HX. Head growth in preterm infants: correlation with magnetic resonance imaging and neurodevelopmental outcome. Pediatrics 2008; 121: e1534-40. DOI: https://doi.org/10.1542/peds.2007-2671
Covas M, Alda E. Morbilidad neonatal y evaluación neuromadurativa a los 15 meses en una población de recién nacidos con peso de nacimiento < 1500g. Proceedings of the 9º Jornadas de Neonatología- 6° Jornadas Interdisciplinarias de Seguimiento de Recién nacido de Alto Riesgo. Poster N° 30. 20- 23 de Agosto. Bahía Blanca (Bs. As.), SAP.2008.
Benítez A, Visentin P. Qué es la Retinopatía del Prematuro? En: Prevención de la ceguera en la infancia por Retinopatía del prematuro. Bs. As.: UNICEF & Min Sal. 2008; pp. 12-20.