Morbimortalidad en recién nacidos de muy bajo peso en el control de la calidad de la asistencia perinatal

Abstract

Objective To compare the clinical outcomes of a cohort of very low birth weight (VLBW) infants who received healthcare in our unit from 1994-2000 with all the variables included in the Vermont-Oxford Network (VON) database. Methods A historical cohort of 417 VLBW live infants born in our center from 1994-2000 was evaluated. The 80 variables of the VON already prospectively included in the unit's database were used and a further 20 variables were added through retrospective review of medical records. The rates of perinatal risk factors, interventions, and causes of morbidity were analyzed and the periods 1994-1997 and 1998-2000 were compared. We also compared these rates with those reported by the VON. Results Comparison of the results in both periods showed an increase in the percentage of multiple pregnancies and prenatal corticosteroid exposure, as well as in the early use of surfactant and continuous positive pressure. The incidence of intraventricular hemorrhage decreased, but no differences were observed in other outcomes. Our rates of Cesarean sections and multiple births, as well as the use of prenatal steroids, were higher than those of the VON. The outcomes of infants receiving healthcare in our unit were similar to those of the VON but mortality in infants weighing < 800 g was slightly higher, coinciding with higher rates of late sepsis. Conclusion Morbidity rates in VLWB infants receiving care in our unit decreased during the period studied and compared favorably with those reported by the VON. Alltogether, our results indicate that the quality of care in our perinatal center is good. General use of this methodology would permit comparison of outcomes and quality of care across regions and nations, as well as across Europe, in a recently established network (EuroNeoNet.com).