PhD Scientific Days 2024

Budapest, 9-10 July 2024

Conservative Medicine

Composite outcome trends of very low birth weight infants between 2014 and 2021 in Hungary: a population-based study

Author(s)

Csaba Péter Nádor1, Andrea Valek2, Attila Juhász3, Csilla Nagy3, Eszter Bodrogi4, Miklós Szabó5, Ágnes Jermendy5
1: Neonatal Intensive Care Unit, Ulloi Street Division, Department of Obstetrics and Gynecology, Semmelweis University
2: Department of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest and Heim Pál Children's Hospital, Budapest
3: National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest
4: Neonatal Intensive Care Unit, Central Hospital of Northern Pest – Military Hospital, Budapest
5: Department of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest

Text of the abstract

Introduction
Premature birth is a major public health problem worldwide, considered to be one of the main risk factors for neonatal mortality. Health care after birth largely determines disability adjusted life years (DALY) of premature babies, especially those weighing less than 1500 grams at birth (very low birth weight infants (VLBW)).
Aims
To present trends of composite outcome, including mortality and any of the five major morbidities threatening VLBW infants in Hungary. It was assumed that the performance of neonatal intensive care units (NICU) varies across the country.
Methods
NICU performance was analysed between 2014 and 2016 (Epoch 1); and between 2019 and 2021 (Epoch 2) in a retrospective cohort study involving all the 21 Level III NICUs in Hungary. The primary outcome was defined as a composite indicator. For key outcomes, we followed a three-step approach of analysis: crude rates, multivariable risk-adjusted models, and smoothed models. For the key outcomes a three-step analytical approach was used: raw rates, multivariate risk-adjusted models, and smoothed models. The association between the deprivation and NICU performance was evaluated in Epoch 2 using Pearson’s correlation.
Results
The composite outcome decreased from 38.4% in Epoch 1 (n=3398) to 33.8% in Epoch 2 (n=3060) (p<0.0001). The mortality rate decreased by 1.4 percentage points (p=0.067). The rate of late onset sepsis (LOS) decreased by 4.9% in Epoch 2 (p=<0.0001). The percentage of patients with disease-free survival increased from 61.6 to 66.1% (p= 0.0114). There was a 5% decrease in the odds of adverse composite outcome yearly (aOR 0.95 (95% C.I. 0.92-0.97). The multilevel logistic regression model adjusted for case-mix and the volume of admission has revealed that there was a significant between center variability in the composite outcome. The odds of composite outcome has shown no correlation with the deprivation (r=-0.1363, p=0.578).
Conclusions
The composite outcome of death and 5 major morbidities of VLBW infants have decreased significantly over the 2014-16 and 2019-21 periods in Hungary. A marked variability exists between NICUs that could not be explained by patient characteristics, patient volume or the deprivation.
Funding
No funding was received.