Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s
Objectives It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22–27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s.Design Prospective lon...
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| Format: | Article |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e037507.full |
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| author | Alicia J Spittle Lex W Doyle Peter J Anderson Li Huang Jeanie L Y Cheong Alice C Burnett Anjali Haikerwal Merilyn Bear Margaret Charlton Janet Courtot Noni Davis Julianne Duff Rachel Ellis Marie Hayes Elisha Josev Elaine Kelly Marion Mcdonald Emma Mcinnes Bronwyn Novella Gillian Opie Gehan Roberts Katherine Scott Penelope Stevens Anne-marie Turner Kim M Dalziel Katherine Lee Marissa Clark Joy E Olsen Rosemarie A Boland Alice E Stewart Leah M Hickey |
| author_facet | Alicia J Spittle Lex W Doyle Peter J Anderson Li Huang Jeanie L Y Cheong Alice C Burnett Anjali Haikerwal Merilyn Bear Margaret Charlton Janet Courtot Noni Davis Julianne Duff Rachel Ellis Marie Hayes Elisha Josev Elaine Kelly Marion Mcdonald Emma Mcinnes Bronwyn Novella Gillian Opie Gehan Roberts Katherine Scott Penelope Stevens Anne-marie Turner Kim M Dalziel Katherine Lee Marissa Clark Joy E Olsen Rosemarie A Boland Alice E Stewart Leah M Hickey |
| collection | DOAJ |
| description | Objectives It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22–27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s.Design Prospective longitudinal cohort study.Setting The State of Victoria, Australia.Participants All EP births offered intensive care in four discrete eras (1991–1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016–March 2017 (12 months): n=250).Outcome measures Consumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated.Results Median duration of any respiratory support increased from 22 days (1991–1992) to 66 days (2016–2017). The increase occurred in non-invasive respiratory support (2 days (1991–1992) to 51 days (2016–2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016–2017. Survival to discharge home increased (68% (1991–1992) to 87% (2016–2017)). Cystic periventricular leukomalacia decreased (6.3% (1991–1992) to 1.2% (2016–2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991–1992) to 10.0% (2016–2017)). The average additional costs associated with one additional infant surviving in 2016–2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991–1992, 1997 and 2005, respectively.Conclusions Consumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined. |
| first_indexed | 2024-12-17T07:31:49Z |
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| id | doaj.art-6996c0d924c345fd88b3513f53363271 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-02-17T05:17:04Z |
| publishDate | 2020-09-01 |
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| spelling | doaj.art-6996c0d924c345fd88b3513f533632712025-01-08T19:35:13ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-037507Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s 0Alicia J Spittle1Lex W Doyle2Peter J Anderson3Li Huang4Jeanie L Y Cheong5Alice C Burnett6Anjali Haikerwal7Merilyn BearMargaret CharltonJanet CourtotNoni DavisJulianne DuffRachel EllisMarie HayesElisha JosevElaine Kelly8Marion McdonaldEmma McinnesBronwyn NovellaGillian Opie9Gehan Roberts10Katherine ScottPenelope StevensAnne-marie TurnerKim M Dalziel11Katherine Lee12Marissa Clark13Joy E Olsen14Rosemarie A Boland15Alice E Stewart16Leah M Hickey17GENYO, Pfizer-University, Granada, Spain, Granada, Spain2 Victorian Infant Brain Studies, Murdoch Children`s Research Institute, Parkville, Victoria, AustraliaDepartment of Maternal Fetal Medicine, Royal Women’s Hospital, Parkville, Victoria, AustraliaClinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, AustraliaSchool of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, ChinaNewborn Research, Royal Women`s Hospital, Parkville, Victoria, AustraliaClinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia2 Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, AustraliaInstitute for Fiscal Studies, London, UKDepartment of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia4 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia1 Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia12 Department of Neonatology, Monash Medical Centre, Clayton, Victoria, AustraliaClinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, AustraliaDepartment of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, AustraliaNewborn Services, Monash Medical Centre Clayton, Clayton, Victoria, AustraliaDepartment of Neonatal Medicine, Royal Children’s Hospital, Melbourne, Victoria, AustraliaObjectives It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22–27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s.Design Prospective longitudinal cohort study.Setting The State of Victoria, Australia.Participants All EP births offered intensive care in four discrete eras (1991–1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016–March 2017 (12 months): n=250).Outcome measures Consumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated.Results Median duration of any respiratory support increased from 22 days (1991–1992) to 66 days (2016–2017). The increase occurred in non-invasive respiratory support (2 days (1991–1992) to 51 days (2016–2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016–2017. Survival to discharge home increased (68% (1991–1992) to 87% (2016–2017)). Cystic periventricular leukomalacia decreased (6.3% (1991–1992) to 1.2% (2016–2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991–1992) to 10.0% (2016–2017)). The average additional costs associated with one additional infant surviving in 2016–2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991–1992, 1997 and 2005, respectively.Conclusions Consumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined.https://bmjopen.bmj.com/content/10/9/e037507.full |
| spellingShingle | Alicia J Spittle Lex W Doyle Peter J Anderson Li Huang Jeanie L Y Cheong Alice C Burnett Anjali Haikerwal Merilyn Bear Margaret Charlton Janet Courtot Noni Davis Julianne Duff Rachel Ellis Marie Hayes Elisha Josev Elaine Kelly Marion Mcdonald Emma Mcinnes Bronwyn Novella Gillian Opie Gehan Roberts Katherine Scott Penelope Stevens Anne-marie Turner Kim M Dalziel Katherine Lee Marissa Clark Joy E Olsen Rosemarie A Boland Alice E Stewart Leah M Hickey Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s BMJ Open |
| title | Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s |
| title_full | Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s |
| title_fullStr | Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s |
| title_full_unstemmed | Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s |
| title_short | Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s |
| title_sort | changing consumption of resources for respiratory support and short term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s |
| url | https://bmjopen.bmj.com/content/10/9/e037507.full |
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