Utjecaj postojeće regionalizacije zdravstvene zaštite novorođenčadi na pomor novorođenčadi vrlo niske ududporodne težine u dvogodišnjem razdoblju (1998-1999.) ududu Republici Hrvatskoj Influence of present regionalization of neonatal health care on mortality of very low birth weight infants in a two-year period (1998-1999.) in Republic of Croatia

摘要

This is the first national study of survival of very-low-birth-weight (VLBW) infants to discharge from hospital in Republic of Croatia. In the period 1.1.1998.-31.12.1999., 672 VLBW infants were live-born, and they consisted 0.72% of all liveborns.ududAmong them, 663 had known outcome, and 51.9% of them survived to discharge from hospital. Out of 672 infants, 25.2% were born in maternities with level I. neonatal facilities, 13.5% in maternities with level II. neonatal facilities, and 61.3% in maternities with level III. neonatal facilities, respectively. The number of newborns which were born in maternities with level III. neonatal facilities is smaller than that in countries with regionalized perinatal care.ududIn further analysis the influence of risk factors to survival to discharge was investigated. Number of infants in this group was reduced to these who fulfilled the criteria (N=538). Average birth-weight was 1177.9 ± 227.3 g, average gestational age was 29.5 ± 2.9 completed weeks, and average CRIB score was 4.86.ududSurvival to discharge from hospital in this group was 61%, early neonatal mortality was 28.1%, and neonatal mortality was 36.1%. In investigated population of very low birth weight infants neonatal and postneonatal mortality is greater than in more developed countries.ududCRIB score is shown to be better predictor of survival of these infants to discharge from hospital than birth weight and gestational age.ududAnalysis of standardized mortality ratio by CRIB score showed that survival to discharge was greatest in infants who were born in maternities with level III. neonatal facilities, than in infants who were born in maternities with level II. neonatal facilities, and lowest in infants who were born in maternities with level I. neonatal facilities. Ranking of different levels of neonatal facilities by survival obtained by crude mortality was the same as ranking obtained by standardized mortality ratio by CRIB score. ududOverall 98 infants were transferred to neonatal facilities of higher organizational level in the first 36 hours of age. Outcomes of all infants were attributed to the levels of neonatal facilities where they were treated longer period from 12th to 72nd hours of life. Of 538 infants, 58 were treated in level I. neonatal facilities, 73 in level II. neonatal facilities, and 407 in level III. neonatal facilities, respectively. ududRanking of these patient subgroups and levels of neonatal facilities by survival obtained by crude mortality was different than ranking by survival obtained by standardized mortality ratio by CRIB score. Level III. neonatal facilities were found to be the best place for delivery, but also for the treatment of such infants. Level III. neonatal facilities also improved the survival for infants postnataly transferred from level I. and level II. neonatal facilities.ududududIt can be concluded that is necessary, in the aim of increasing survival of these infants, to increase proportion of infants to be born in maternities with level III. neonatal facilities by forcing transportation "in utero". For those infants born in maternities with level I. and II., postnatal transportation should be forced toward level III. neonatal facilities.ududAlso, it can be suggested to collect the data for completing the CRIB score of such infants routinely, in attempt to compare the outcome between perinatal and neonatal facilities more fairly, taking into account the specificities of each patient caused by severity of initial disease.