ORIGINAL ARTICLE
Morbidity and mortality in newborns at the limit of viability in Spain: A population-based study
Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional
F. García-Muñoz Rodrigoa,
, A. García-Alix Pérezb, J.A. García Hernándezc, J. Figueras Aloyd, Grupo Sen1500
Corresponding author
a Servicio de Neonatología, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
b Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
c Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
d Hospital Clínic, Barcelona, Spain
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The aim of this study was to determine the specific rates of survival at hospital discharge, and survival without major morbidity in newborns with a gestation age (GA) ≤ 26 weeks in Spain.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We included live newborns ≤ 26 weeks admitted to the collaborating centres of the SEN1500 network (2004-2010). Outborn patients, infants who died in delivery room, and those with congenital anomalies incompatible with life were excluded.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 3,236 patients were included. GA specific survival was 12.5, 13.1, 36.9, 55.7, and 71.9% at 22, 23, 24, 25, and 26 weeks of GA, respectively. Survival without severe intracranial haemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or retinopathy of prematurity was 1.5, 9.5, 19.0, and 29.9% at 23, 24, 25 and 26 weeks GA, respectively.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Survival without major morbidity in infants less than 23 weeks GA is exceptional, and scarce in newborns with 23 and 24 weeks GA. Infants ≥ 25 weeks GA have reasonable chances of survival and, in the absence of major malformations or other relevant complications, they should be offered active resuscitation and intensive care. The continuous updating of the results of individual centres is of utmost importance, as well as their comparison with the reference population-based results.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La asistencia perinatal a recién nacidos (RN) extremadamente inmaduros constituye un problema clínico y ético de gran trascendencia para profesionales y familias, y hace necesaria una información actualizada de la máxima calidad acerca de las posibilidades de supervivencia del niño. El objetivo de este estudio fue conocer las tasas específicas de supervivencia al alta hospitalaria y de supervivencia sin morbilidad mayor conocida en RN con una edad gestacional (EG) ≤ 26 semanas en España.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron los RN vivos de ≤ 26 semanas que ingresaron en los centros colaboradores de la red SEN1500 (2004-2010). Se excluyeron los nacidos extramuros, los fallecidos en el paritorio y los que tenían malformaciones incompatibles con la vida.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En total 3.236 pacientes fueron incluidos. La supervivencia específica por EG fue de 12,5, 13,1, 36,9, 55,7 y 71,9% a las 22, 23, 24, 25 y 26 semanas de EG, respectivamente. La supervivencia sin hemorragia intracraneal grave, leucomalacia periventricular, displasia broncopulmonar y/o retinopatía de la prematuridad fue del 1,5, 9,5, 19,0 y 29,9% a las 23, 24, 25 y 26 semanas, respectivamente.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La supervivencia sin morbilidad mayor en menores de 23 semanas de EG es excepcional, y en RN de 23 y 24 semanas, muy baja. Los RN ≥ 25 semanas de EG tienen posibilidades razonables de supervivencia y, en ausencia de malformaciones mayores u otras complicaciones relevantes, se les debería ofrecer reanimación activa y cuidados intensivos. Es fundamental la actualización continua de los datos propios de cada centro y su comparación con los resultados poblacionales de referencia.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Muñoz Rodrigo F, García-Alix Pérez A, García Hernández JA, Figueras Aloy J, Grupo SEN1500. Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional. An Pediatr (Barc). 2014;80:348-356.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The EPICure Study Group. 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| Year/Month | Html | Total | |
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| 2024 November | 3 | 11 | 14 |
| 2024 October | 51 | 55 | 106 |
| 2024 September | 71 | 50 | 121 |
| 2024 August | 73 | 92 | 165 |
| 2024 July | 44 | 41 | 85 |
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| 2024 May | 41 | 36 | 77 |
| 2024 April | 48 | 53 | 101 |
| 2024 March | 41 | 25 | 66 |
| 2024 February | 45 | 35 | 80 |
| 2024 January | 45 | 21 | 66 |
| 2023 December | 28 | 19 | 47 |
| 2023 November | 50 | 25 | 75 |
| 2023 October | 30 | 22 | 52 |
| 2023 September | 31 | 23 | 54 |
| 2023 August | 31 | 19 | 50 |
| 2023 July | 25 | 27 | 52 |
| 2023 June | 31 | 27 | 58 |
| 2023 May | 43 | 26 | 69 |
| 2023 April | 16 | 17 | 33 |
| 2023 March | 33 | 22 | 55 |
| 2023 February | 26 | 14 | 40 |
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| 2022 December | 24 | 22 | 46 |
| 2022 November | 39 | 38 | 77 |
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| 2022 July | 31 | 48 | 79 |
| 2022 June | 31 | 33 | 64 |
| 2022 May | 24 | 50 | 74 |
| 2022 April | 39 | 33 | 72 |
| 2022 March | 55 | 65 | 120 |
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| 2022 January | 44 | 43 | 87 |
| 2021 December | 25 | 43 | 68 |
| 2021 November | 30 | 54 | 84 |
| 2021 October | 42 | 61 | 103 |
| 2021 September | 16 | 58 | 74 |
| 2021 August | 17 | 41 | 58 |
| 2021 July | 22 | 32 | 54 |
| 2021 June | 28 | 30 | 58 |
| 2021 May | 27 | 34 | 61 |
| 2021 April | 56 | 39 | 95 |
| 2021 March | 33 | 43 | 76 |
| 2021 February | 22 | 25 | 47 |
| 2021 January | 16 | 16 | 32 |
| 2020 December | 20 | 19 | 39 |
| 2020 November | 24 | 15 | 39 |
| 2020 October | 28 | 12 | 40 |
| 2020 September | 19 | 17 | 36 |
| 2020 August | 9 | 5 | 14 |
| 2020 July | 20 | 14 | 34 |
| 2020 June | 35 | 15 | 50 |
| 2020 May | 38 | 18 | 56 |
| 2020 April | 22 | 17 | 39 |
| 2020 March | 30 | 17 | 47 |
| 2020 February | 35 | 20 | 55 |
| 2020 January | 20 | 10 | 30 |
| 2019 December | 52 | 28 | 80 |
| 2019 November | 27 | 14 | 41 |
| 2019 October | 26 | 22 | 48 |
| 2019 September | 27 | 17 | 44 |
| 2019 August | 39 | 20 | 59 |
| 2019 July | 27 | 25 | 52 |
| 2019 June | 29 | 19 | 48 |
| 2019 May | 91 | 64 | 155 |
| 2019 April | 67 | 88 | 155 |
| 2019 March | 34 | 27 | 61 |
| 2019 February | 35 | 15 | 50 |
| 2019 January | 39 | 30 | 69 |
| 2018 December | 43 | 35 | 78 |
| 2018 November | 59 | 39 | 98 |
| 2018 October | 66 | 20 | 86 |
| 2018 September | 37 | 20 | 57 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 17 | 0 | 17 |
| 2018 March | 14 | 0 | 14 |
| 2018 February | 11 | 0 | 11 |
| 2018 January | 12 | 0 | 12 |
| 2017 December | 18 | 0 | 18 |
| 2017 November | 26 | 0 | 26 |
| 2017 October | 20 | 0 | 20 |
| 2017 September | 13 | 0 | 13 |
| 2017 August | 16 | 0 | 16 |
| 2017 July | 26 | 0 | 26 |
| 2017 June | 25 | 31 | 56 |
| 2017 May | 33 | 12 | 45 |
| 2017 April | 32 | 13 | 45 |
| 2017 March | 9 | 6 | 15 |
| 2017 February | 14 | 9 | 23 |
| 2017 January | 16 | 7 | 23 |
| 2016 December | 37 | 9 | 46 |
| 2016 November | 58 | 13 | 71 |
| 2016 October | 74 | 9 | 83 |
| 2016 September | 70 | 12 | 82 |
| 2016 August | 42 | 3 | 45 |
| 2016 July | 31 | 16 | 47 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 4 | 0 | 4 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 1 | 0 | 1 |
| 2015 January | 1 | 0 | 1 |
| 2014 December | 2 | 0 | 2 |
| 2014 November | 3 | 0 | 3 |
| 2014 October | 1 | 0 | 1 |
| 2014 September | 3 | 0 | 3 |
| 2014 August | 1 | 0 | 1 |
| 2014 July | 4 | 0 | 4 |
| 2014 June | 15 | 1 | 16 |
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