1174

Archives of Disease in Childhood 1992; 67: 1174-1176

Annual audit of neonatal morbidity in

preterm

infants R W I Cooke

Abstract Annual odds ratios, standardised for known confounding variables, were used to examine trends in major neonatal morbidities among 3220 preterm infants of less than 35 weeks' gestation admitted to a regional referral centre between 1980 and 1991. Despite improved survival, the risk of major cerebral haemorrhage, ventriculoperitoneal shunt insertion, and necrotising enterocolitis was unchanged. A recent reduction in risk of pneumothorax and persistence of the arterial duct was noted. An increased risk for chronic lung disease over time could be accounted for by increased survival, although a similar increase in risk for infection remained unexplained.

Mersey Regional Care Unit, Liverpool Maternity Hospital,

Liverpool

L7 7BN

(Arch Dis Child 1992; 67:1174-6)

Correspondence to:

Medical audit aims to examine critically the .> structure, process, and outcome of medical care. In the field of neonatal intensive care,

Professor Cooke.

Accepted 1 June 1992

Table 1 Definitions of descriptive and outcome variables used in the analyses Descriptive variables: Birth weight Gestation Sex Multiple pregnancy Mode of delivery Place of birth

Birth weight in grams Gestational age in completed weeks Male/female Yes/no Vaginal/caesarean section Inborn/outbom

Outcome variables: Survival

Survival to discharge from unit Ultrasound scan evidence of parenchymal haemorrhage or infarction Oxygen dependency at 28 days with radiographic changes in previously ventilated infant Treament of hydrocephaly by insertion of ventriculoperitoneal or atrial shunt Pneumothorax treated by thoracocentesis Clinical diagnosis of ductal shunt which resulted in change in management Positive blood culture Clinical diagnosis supported by radiographic, surgical, or necropsy findings

Parenchymal haemorrhage BPD

Ventriculoperitoneal shunt Pneumothroax Persistent ductus arteriosus

Septicaemia Necrotising enterocolitis

Table 2 Descriptive variables that significantly changed over the study period 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 Outborn Inborn

78 147

86 183

94 195

85 234

(%)

(65)

(68)

(67)

(73)

Vaginal delivery Caesarean section

155

164

178

70

105

(%)

(31)

111 (39) (38)

76 205

81

88

77

58

204 207 183 161 (73) (71) (73) (67) (73) X2 for trend, 7*55, p=0-006

73 189

65 208

62 181

(72)

(76)

(74) 145

191

140

149

128

154

123

125

145

127

141

136

156

117

96

137

128

98

(52)

(47)

(40)

57 106 99

55 101 117

97 87

(40)

(50) (48) (55) (43) (44) x2 for trend, 13-9, p=0-0002

Gestation (weeks)

Annual audit of neonatal morbidity in preterm infants.

Annual odds ratios, standardised for known confounding variables, were used to examine trends in major neonatal morbidities among 3220 preterm infants...
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