Dicreasing Mortality in Preterm Infants
Prof. Brian Reichman
Prof. Liat Lerner-Geva
Orna Levitski, Database director
Etti Nachtstern, Database coordinator and data entry
Partners at the Gertner Institute
Valentina Boyko, Statistician, Women and Children's Health Research Unit
Saralee Glasser, Researcher, Women and Children's Health Research Unit
Arnona Ziv, Director, Information and Computerization Unit
Oded Ilan, Computer support, Information and Computerization Unit
1. Gertner Institute
2. Israel National Center for Disease Control
3. Information and computerigation unit MCH
4. Israel Neonatology Association
Neonatal Special Care Departments
Holy Family Italian Hospital Nazareth
Nazareth (English-Scottish) Hospital, Nazareth
Assaf Harofeh Medical Center, Zrifin
Bikur Holim. Hospital ShareZedek Medical center, Jerusalem
Bnai Zion Medical Center, Haifa
Barzilai Medical Center, Ashkelon
Hadassah Medical Center, Mount Scopus, Jerusalem
Hadassah Medical Center, Ein Kerem, Jerusalem
Hillel Yaffe Medical Center, Hadera
Ha'emek Medical Center, Afula
Hasharon Hospital, Petach Tikva (1995-96)
Wolfson Medical Center, Holon
Rebecca Sieff Medical Center , Safed
Yoseftal Medical Center, Eilat
Lady Davis Carmel Medical Center, Haifa
Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv
Laniado Hospital, Kiryat Sanz, Netanya
Meir Medical Center, Kfar Sava
Maaynei Hayeshua Medical Center, Bnei Brak
Misgav Ladach Hospital, Jerusalem (1995-2000)
Western Galilee Medical Center, Nahariya
Soroka Medical Center, Be'er Sheva
Poriya Medical Center, Tiberias
St. Vincent (French) Hospital, Nazareth
Kaplan Medical Center, Rehovot
Rambam Medical Center, Haifa
Sheba Medical Center, Tel Hashomer
Shaare Zedek Medical Center, Jerusalem
Schneider Children's Medical Center, Rabin Medical Center (Beilenson), Petach Tikva
Twenty years of progress in treatment and outcome ********
Infants born at a very low birth weight (VLBW, less than 1500 grams [3.5 lbs]) account for approximately 1% of all live births in Israel, but account for 45% of the neonatal deaths nationally and approximately 15% of the severe developmental disabilities in infants. They make up approximately 45% of the total hospital-days in Neonatal Intensive Care Units.
In 1993, the Israel Neonatology Association***** proposed that the Ministry of Health establish a national database of data on mortality, morbidity and long-term development of VLBW infants, with the goal of reducing the neonatal death rate in Israel, identifying perinatal factors related to mortality, morbidity and delayed development, and to describe trends and patterns of morbidity, mortality and treatments in this group.
Further to this proposal, the National Council for Gynecology, Genetics and Neonatology recommended the establishment of a national epidemiological database to evaluate obstetric results, mortality and morbidity of infants, which could serve as the foundation for a system for monitoring and controlling the levels of perinatal and infant mortality, the occurrence of congenital defects, excessive pre-maturity, exceptional morbidity and disability.
As part of this national database, the National VLBW Database was established in 1995, at the initiative of the Israel Association for Neonatology and with the support of the directors of all of the neonatal departments in Israel. The database was established within the framework of the Israel National Center for Disease Control ***** and is operated by the Women and Children's Health Research Unit of the Gertner Institute for Epidemiology and Health Policy Research.*******
Now, 20 years after its establishment, the database includes close to 30,500 infants born from 1995 through 2014. The data is based on reports received from 27 Neonatal and Neonatal Special Care Units in Israel and includes information about the socio-demographic background of the parents, the mothers' obstetric history, morbidity and treatments during the current pregnancy, course of the current pregnancy and condition of the infant at birth, course of hospitalization including type and severity of illness, type and extent of treatment to given and the infant's condition upon discharge.
The purpose of the database is to create a foundation of epidemiological data to help reduce the national infant mortality rate and identify perinatal conditions linked to mortality, morbidity and disability among VLBW infants by identifying trends related to mortality, morbidity and the impact of changes in the technology and treatments of mothers and newborns on the survival of infants, and identify perinatal situations related to the children's handicaps and disabilities in later years, through a long-term follow-up.
______________a greater survival rate among infants born at very low birth weight. This group of infants is an economic burden because of their need for lengthy hospitalizations, both immediately after birth and throughout their lives. It is therefore very important to focus on this group and plan the health services and resources they require. The database, which is a unique national project, is very important because it makes this possible.
The database is an auxiliary tool for planning and managemnt at several levels :
- At the national level, data from the database is used by Knesset committees dealing with promoting subjects related to neonatal health in Israel.
- At the level of the Ministry of Health and other agencies that plan and allocate resources as a tool for evaluating the impact of treatments and interventions.
- At the department level by identifying deficiencies and shortages, improving the quality of care and promoting preventative processes.
Every year a special report on a selected subject covered by the database is published and sent to all of the relevant people and agencies in the health system. To date, the following special reports of been published:
- Late septicemia among VLBW infants: Trends 1995-2007
(Published in 2009)
- Mortality rates among infants born in the 23-26 weeks of pregnancy - Tool for assessing estimated mortality rates
(Published in 2008)
- Trends in the number of live births of VLBW infants and multiple births 1996-2005
(Published in 2007)
- Percentage of mortality, morbidity and treatment in VLBW infants, by weight and gestational week at birth in 1995-1999, compared with 2000-2004
(Published in 2006).
- Trends in mortality, morbidity and treatment in VLBW infants in 1995-2003
(Published in 2005)
- Birth defects among VLBW infants 1995-2002
(Published in 2004)
- Mortality of VLBW infants after release from hospital 1995-2002
(Published in 2004)
- Mortality rate of VLBW infants born in Israel compared with other countries in 1995-2001
(Published in 2003)
- Trends in the rate of VLBW live births and multiple live births and the duration of hospitalization in 1996-2000
(Published in 2002)
- Impact of lowering the number of triplet births on the number hospitalization-days in Neonatal Special Care and Premature Infants Departments
(Published in 2000)
- Results of intensive intervention effect on marginally-viable newborns
(Published in 2000)
- Morbidity and mortality among Arab VLBW newborns in Israel
(Published in 2000)
The Scientific Committee, comprised of representatives of the directors of Neonatal Special Care Departments, approves research reports based on data from the database. Several articles have been published in international, professional journals and scientific have been presented at scientific conferences and a variety of national and international forums.
The international Network for Evaluating Outcomes (iNeo) in neonates is an international collaboration that will include 11 pupulation-based national neonatal networks of Australia and New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland and the U.K., Italy, (Toscany) and Finland. The main aim in forming iNeo is to provide a powerful platform for applied health sevices and policy rsearch that can be used to improve patient-oriented outcomes for very low birth weight (VLBW, born weighing <1,500g) infants and ... extremely premature babies born at less than 32 weeks of gestation, in the member countries and globally. Data from each of the iNeo member networks will be used for comparative analysis of neonatal outcomes between networks.
Based on evidence obtained using the iNeo platform, research teams form all member networks will be able to identify, implement, and evaluate practice/service provision changes aimed at improving and care and outcomes of VLBW infants within their respective countries.
The iNeo collaboration will also provide opportunities for training the next generation of rsearch in Neonatal-Perinatal health services research.
At two years
In 1997-1998, 1104 VLBW infants born in 1995-1996 underwent developmental testing conducted by the database, in order to describe their developmental condition and measure the rate of disability in this population at age two. A report on the results of the two-year tests was published in May 2003.
Background and method
The VLBW infant database's work included a developmental evaluation program for infants in the database when they reached the age of two and an estimate of the functional disability rate in this group. Areas examined included neuro-motor performance, communications, sensory problems, use of paramedical treatments and growth.
The population monitored included 1,104 children born in 1995-1996 with very low birth weights (59.2% survivors), whose developmental status at two-years was assessed according to the protocol of National Perinatal Epidemiology Unit, Oxford, England.
At five years
In 2000-2001, developmental testing was done of VLBW infants born in 1995, when they reached age five. The purposes of the tests were to describe their developmental condition before they entered the educational system and compare their data at age five with the perinatal data and their condition at age two.
The partners in the five year follow-up study were the Women and Children's Health Research Unit of the Gertner Institute, the Israel National Center for Disease Control, Department of Mother, Child and Adolescent of the Public Health Department and Child Development and Rehabilitation of the Ministry of Health's Health Division. The program included an in-depth examination of the children's medical condition, neurological, cognitive, motor and behavioral functioning, prior to beginning school.
Background and method
The research population included 739 five-year-old children out of 855 surviving VLBW children born in 1995. Tests included evaluation of their cognitive, neuro-motor and integrated visual-motor functioning and neurological testing. The parental questionnaire asked about the child's behavior, attention deficit hyperactivity disorder, sensory processing and home environment. Demographic data and information about educational frameworks, hospitalization, surgery and the use of health and paramedical services was also collected.