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Klin Padiatr 2012; 224(04): 276-281
DOI: 10.1055/s-0032-1306344
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© Georg Thieme Verlag KG Stuttgart · New York

Major Contributors to Hospital Mortality in Very-Low-Birth-Weight Infants: Data of the Birth Year 2010 Cohort of the German Neonatal Network

Hauptursachen der Mortalität bei sehr kleinen Frühgeborenen: Daten der Geburtskohorte 2010 des Deutschen Frühgeborenennetzwerks
G. Stichtenoth
1   Children’s Hospital, University of Lübeck, Germany
,
M. Demmert
1   Children’s Hospital, University of Lübeck, Germany
,
B. Bohnhorst
2   Neonatology, Medical School Hannover, Germany
,
A. Stein
3   Neonatology, Children’s Hospital I, University of Essen, Germany
,
S. Ehlers
4   Neonatology, Burgerhospital Frankfurt, Germany
,
F. Heitmann
5   Department of Pediatrics, Community Hospital Dortmund, Germany
,
E. Rieger-Fackeldey
6   Neonatology, University of Münster, Germany
,
D. Olbertz
7   Neonatology, Klinikum Rostock Süd, Rostock, Germany
,
C. Roll
8   Department of Neonatology and Pediatric Intensive Care, Vest Children’s Hospital, Datteln, Germany
,
M. Emeis
9   Neonatology, Vivates Klinikum Berlin, Germany
,
M. Mögel
10   Neonatology, University of Dresden, Germany
,
H. Schiffmann
11   Neonatology, Childrens Hospital Nürnberg, Germany
,
C. Wieg
12   Neonatologie, Klinikum Aschaffenburg, Germany
,
J. Wintgens
13   Neonatology, Klinikum Mönchengladbach, Germany
,
E. Herting
1   Children’s Hospital, University of Lübeck, Germany
,
W. Göpel
1   Children’s Hospital, University of Lübeck, Germany
,
C. Härtel
1   Children’s Hospital, University of Lübeck, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 March 2012 (online)

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Abstract

Rationale:

The German Neonatal Network (GNN) is a prospective cohort study with the focus on long term development of very-low-birth-weight infants. It was the aim of this study to determine detailed information on causes of mortality in the GNN birth cohort 2010.

Methods:

Major contributors to hospital mortality were recorded by the attending neonatologists for the cohort of very-low-birth-weight (VLBW) infants born in centres of the German Neonatal Network (GNN) in 2010. The data quality was approved by on-site monitoring.

Results:

2 221 VLBW infants were born in GNN centres in 2010, and death occurred in 221 infants. Male infants carried a higher risk than females (58.8% males among non-survivors vs. 51.7% among survivors, p=0.047). In 11 infants, the major contributor to death was not determined by the attending neonatologist. In 25 infants born at the limit of viability, comfort palliative care was primarily initiated and 14 infants had lethal malformations. The majority of non-survivors suffered from inflammatory diseases including sepsis- or necrotizing enterocolitis (NEC)-associated death (n=56). Respiratory pathology was a major contributor to death in 65 infants including 11 infants who died from pulmonary haemorrhage.

Conclusions:

Potentially preventable complications of preterm birth such as sepsis, NEC and pulmonary haemorrhage predominate the major contributors to mortality in the GNN 2010 cohort. In order to decrease the rate of these associated deaths, future trials should focus on prophylaxis and therapy optimization strategies for these outcomes.

Zusammenfassung

Hintergrund:

Das Deutsche Frühgeborenennetzwerk (German Neonatal Network; GNN) ist eine prospektive Untersuchung zum Langzeitoutcome von Frühgeborenen mit einem Geburtsgewicht < 1 500 g. In diesem Bericht werden die wichtigsten kausalen Faktoren für Mortalität bei sehr kleinen Frühgeborenen, die im Geburtsjahrgang 2010 in GNN-Zentren geboren wurden, dargestellt.

Methoden:

Die ursächlichen Faktoren für das Versterben während des ersten Klinikaufenthalts wurden von den betreuenden Neonatologen festgelegt und die Datenqualität durch Monitoring vor Ort überprüft.

Ergebnisse:

2 221 sehr kleine Frühgeborene wurden 2010 in GNN-Kliniken geboren, von denen 221 verstarben. Männliche Frühgeborene hatten ein höheres Mortalitätsrisiko (58,8% der verstorbenen Kindern männlich, vs. 51,7% der überlebenden Frühgeborenen männlich, p=0,047). Bei 11 Frühgeborenen konnte der hauptsächliche Einflussfaktor für Mortalität nicht determiniert werden. 25 Frühgeborene wurden primär palliativ versorgt, 14 Frühgeborene hatten letale Fehlbildungen. Inflammatorische Erkrankungen, einschl. Sepsis und nekrotisierende Enterocolitis (NEC) wurden als hauptsächliche Todesursache bei n=56 Frühgeborenen genannt. Respiratorische Erkrankungen spielten bei 65 Frühgeborenen eine Rolle, einschl. 11 Frühgeborenen, die aufgrund einer Lungenblutung verstarben.

Schlussfolgerungen:

Potenziell vermeidbare Komplikationen der Frühgeburtlichkeit (Sepsis, NEC, Lungenblutung) dominieren als die wichtigen Faktoren, die mit Mortalität bei Frühgeborenen der GNN-2010-Kohorte assoziiert sind. Zukünftige Studien sollten daher auf Prävention und Therapieoptimierung für diese Komplikationen abzielen.

Key words

mortality - very low birth weight infants - sepsis - respiratory distress syndrome

Schlüsselwörter

Mortalität - sehr kleine Frühgeborene - Sepsis - Atemnotsyndrom
 

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