Introduction: Although many therapeutic interventions have proven efficacy through randomized control trials (RCT) with extensive use in Neonatal Intensive Care Units (NICU) for Very Low Birth Weight Infants (VLBWI), doubts remain about its overall effectiveness.
Objective: To determine changes in the effectiveness of NICU practices on VLBWI over 14 years in the quality of neonatal survival in a General Hospital, with emphasis in the change in reanimation practices by the introduction of the spread use of surfactant.
Methods: We included all consecutive VLBWI admitted in our NICU during a period of 14 years: 1989-1992 (n= 145); 1993-2002 (n= 342). All survivors were included in our follow-up program; 80% and 85% were available for assessment at two years of corrected age. The patients were assigned to 4 groups by weight in 250 g categories, between 500 and 1500 g.
Outcome measures: Survival and adjusted quality of survival (QS). The QS was expressed in life-years gained. We create categories for the estimation of disabilities. We also analyzed time of NICU stay by weight and mortality categories during the 2 periods.
Results: The survival rate improved significantly between the 2 periods (23%) from 52% to 75%. The actuarial survival showed a significant increase in all weight groups (p <0.001), especially between 500-749 g (4% vs. 33%). The life-years gained showed differences in the BW <750 g (p <0.002, 3.6 vs. 23.4) y 750-999 g (p <0.001, 22.3 vs. 48); no differences were found in the others groups. The time of stay showed an increase of 30 days in the <750 g group (p <0.01) and decreased 8 days in the> or =1250 g group (p <0.01).
Conclusion: The effectiveness of neonatal intensive care for VLBWI improved in the period 1993-2002, after surfactant introduction, especially in the group <1000 g.