Arch Dis Child Fetal Neonatal Ed 1999;80:F111-F114 ( March )

Survival and place of delivery following preterm birth: 1994-96

David Field,^b Elizabeth S Draper^a

^a Department of Epidemiology and Public Health, University of Leicester, ^b Department of Child Health, University of Leicester Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65 Leicester LE2 7LX.

Correspondence to: Professor David Field.

Accepted 18 August 1998

AIMTo compare the survival of premature infants, adjusted for disease severity, in different types of neonatal intensive care setting.
METHODSA prospective observational study in the Trent Health Region was carried out of all infants born to resident mothers at or before 32 weeks of gestation between 1 January 1994 to 31 December 1996 inclusive. The 16 neonatal units in Trent were subdivided into five relatively large units which regularly took outside referrals and 11 smaller units which provided intensive care for a variable proportion (sometimes nearly 100%) of their local population. Data regarding obstetric management, neonatal care, and outcome were collected by independent neonatal nurses who visited the units on a regular basis. Survival rates were compared with an expected rate calculated using the Clinical Risk Index for Babies (CRIB). For either setting to be abnormally good or bad actual deaths had to exceed the 95% confidence interval of the CRIB estimate.
RESULTSActual survival rates for infants 32 weeks gestation and for the group of babies 28 weeks gestation fell within the 95% confidence interval of the rate predicted by CRIB for both the larger referral units and the smaller district units. Similarly, compared with the CRIB prediction, infants transferred in utero or postnatally were not adversely affected in terms of the number who died.
CONCLUSIONPrevious results from this geographical population, showing that survival of babies 28 weeks gestation was better when their care was provided by referral units, are no longer sustained. Significant changes to the neonatal services over time make the current results plausible. However, the new structure poses potential threats to the teaching, training, and research base of the neonatal service as a whole.

Keywords: survival; intensive care; CRIB; prematurity

---

© 1999 by Archives of Disease in Childhood
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Field, D, Bajuk, B, Manktelow, B N, Vincent, T, Dorling, J, Tarnow-Mordi, W, Draper, E S, Smart, D H. (2008). Geographically based investigation of the influence of very-preterm births on routine mortality statistics from the UK and Australia. Arch. Dis. Child. Fetal Neonatal Ed. 93: F212-F216 [Abstract] [Full Text]  
• Van Reempts, P., Gortner, L., Milligan, D., Cuttini, M., Petrou, S., Agostino, R., Field, D., den Ouden, L., Borch, K., Mazela, J., Carrapato, M., Zeitlin, J., for the MOSAIC Research Group, (2007). Characteristics of Neonatal Units That Care for Very Preterm Infants in Europe: Results From the MOSAIC Study. Pediatrics 120: e815-e825 [Abstract] [Full Text]  
• Draper, E. S, Zeitlin, J., Field, D. J, Manktelow, B. N, Truffert, P. (2007). Mortality patterns among very preterm babies: a comparative analysis of two European regions in France and England. Arch. Dis. Child. Fetal Neonatal Ed. 92: 356-360 [Abstract] [Full Text]  
• Cusack, J. M, Field, D. J, Manktelow, B. N (2007). Impact of service changes on neonatal transfer patterns over 10 years. Arch. Dis. Child. Fetal Neonatal Ed. 92: F181-F184 [Abstract] [Full Text]  
• Marlow, N., Bryan Gill, A (2007). Establishing neonatal networks: the reality. Arch. Dis. Child. Fetal Neonatal Ed. 92: F137-F142 [Abstract] [Full Text]  
• Kamoji, V. M., Dorling, J. S., Manktelow, B. N., Draper, E. S., Field, D. J. (2006). Extremely Growth-Retarded Infants: Is There a Viability Centile?. Pediatrics 118: 758-763 [Abstract] [Full Text]  
• Hameed, B., Shyamanur, K., Kotecha, S., Manktelow, B. N., Woodruff, G., Draper, E. S., Field, D. (2004). Trends in the Incidence of Severe Retinopathy of Prematurity in a Geographically Defined Population Over a 10-Year Period. Pediatrics 113: 1653-1657 [Abstract] [Full Text]  
• Draper, E S, Manktelow, B N, McCabe, C, Field, D J (2004). The potential impact on costs and staffing of introducing clinical networks and British Association of Perinatal Medicine standards to the delivery of neonatal care. Arch. Dis. Child. Fetal Neonatal Ed. 89: F236-F240 [Abstract] [Full Text]  
• Joyce, R, Webb, R, Peacock, J L (2004). Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality. Arch. Dis. Child. Fetal Neonatal Ed. 89: F51-F56 [Abstract] [Full Text]  
• Blackmon, L. R. (2003). The Role of the Hospital of Birth on Survival of Extremely Low-birthweight, Extremely Preterm Infants. NeoReviews 4: e147-152 [Full Text]  
• Field, D, Manktelow, B, Draper, E S (2002). Bench marking and performance management in neonatal care: easier said than done!. Arch. Dis. Child. Fetal Neonatal Ed. 87: F163-164 [Full Text]  
• Field, D, Petersen, S, Clarke, M, Draper, E S (2002). Extreme prematurity in the UK and Denmark: population differences in viability. Arch. Dis. Child. Fetal Neonatal Ed. 87: F172-175 [Abstract] [Full Text]  
• International Neonatal Network, , Consultants, S. N., Group, N. C. S. (2000). Risk adjusted and population based studies of the outcome for high risk infants in Scotland and Australia. Arch. Dis. Child. Fetal Neonatal Ed. 82: 118F-123 [Abstract] [Full Text]  
• Vyas, J, Field, D, Draper, E S, Woodruff, G, Fielder, A R, Thompson, J, Shaw, N J, Clark, D, Gregson, R, Burke, J, Durbin, G (2000). Severe retinopathy of prematurity and its association with different rates of survival in infants of less than 1251 g birth weight. Arch. Dis. Child. Fetal Neonatal Ed. 82: 145F-149 [Abstract] [Full Text]