Trends in outcomes of very preterm infants in Romania: A tale of three cities

BackgroundAlthough survival of preterm infants has improved, prematurity remains the second most frequent cause of death before 5years of age in Romania. Data on the changing mortality of Romanian preterm infants born before 29weeks of gestation have not been available. MethodsOutcomes of infants of gestational age 25-28weeks born in 2007-2010 (n=247) were compared with those born in 2011-2014 (n=235). Data were analyzed from three tertiary neonatal intensive care centers. Mortality rates and major morbidities were compared between these two epochs. ResultsInfants in the later epoch were more likely to have been born by cesarean section and had higher 1 and 5min Apgar scores. Mortality rate decreased significantly with increasing gestational age at birth. Between the two epochs, the in-hospital mortality rate decreased from 65.6% to 29.4% (P<0.001); death in the first 48h decreased from 30.0% to 8.5% (P<0.001); and prevalence of severe intraventricular hemorrhage decreased from 52.2% to 11.9% (P<0.001). There were significant increases in the rates of necrotizing enterocolitis and bronchopulmonary dysplasia among survivors but no change in the rate of retinopathy of prematurity. The rate of antenatal corticosteroid use did not change and was only 47% in the more recent epoch (2011-2014). ConclusionsOverall mortality is decreasing, and infants admitted in the later epoch had substantially different rates of mortality and several serious morbidities. The low rate of antenatal corticosteroid use provides an opportunity for further reductions in mortality and morbidity among very preterm infants born in Romania.