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Newborn Services Annual Clinical Report, 2010

Newborn Services Annual Clinical Report, 2010. Commentary by Dr David Knight Director of Neonatology Mater Mothers’ Hospital Brisbane Australia. Mater Mothers’ Hospital. New hospital opened in 2008 9500 births a year 79 cot newborn nursery 37 ICU (= CPAP or more) 1700 admissions

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Newborn Services Annual Clinical Report, 2010

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  1. Newborn Services Annual Clinical Report, 2010 Commentary by Dr David Knight Director of Neonatology Mater Mothers’ Hospital Brisbane Australia

  2. Mater Mothers’ Hospital • New hospital opened in 2008 • 9500 births a year • 79 cot newborn nursery • 37 ICU (= CPAP or more) • 1700 admissions • 271 VLBW infants • (NWH 176)

  3. “MMH” In this presentation MMH refers to Mater Mothers’ Hospital NOT Middlemore Hospital

  4. Acuity and workload Admission rate Very low birth weight admissions Occupancy Assisted ventilation Results and quality Antenatal steroids Hypoxic ischaemic encephalopathy Survival Intraventricular haemorrhage Retinopathy of prematurity Multiple pregnancies Long term outcome Breast feeding Assessing the Newborn Service

  5. Admission rate of inborn babies

  6. Ross Howie David Knight MB Very low birth weight births 1959-2010 Outborn numbers 2000-4 to 2006-10 increased average of 19→33

  7. Very low birth weight births 1959-2010 Outborn numbers 2000-4 to 2006-10 increased average of 19→33

  8. NICU occupancy 2000-2010

  9. NICU occupancy 2000-2010 32-6 weeks 28-31 weeks <28 weeks Term/post-term

  10. Number of babies having assisted ventilation Error 86% increase from 2009 68 outborn 32 term 25 <32 wks Table 78, page 135

  11. Number of babies having assisted ventilation Is there an error in the previous data (table 78)? Figure 97: inborn babies Data from table 78

  12. X X MMH MMH Percentage on IPPV Percentage on CPAP Ventilation in 24-7 week infants X X X X X X X X HFOV use in babies <28 weeks

  13. X MMH X X X X Ventilation in 28-31 week babies

  14. Acuity and workload Admission rate Very low birth weight admissions Occupancy Assisted ventilation Results and quality Antenatal steroids Hypoxic ischaemic encephalopathy Survival Intraventricular haemorrhage Retinopathy of prematurity Multiple pregnancies Long term outcome Breast feeding Assessing the Newborn Service

  15. 24-27 weeks 28-31 weeks X X Antenatal corticosteroid use

  16. Stage 2-3 HIE in inborn babies Hypoxic ischaemic encephalopathy • 5 inborn babies in 2010 • 2 placental abruptions • 3 fetal distress • 9 outborn • 4 Waitakere • 4 North Shore

  17. Survival to 28 days of very low birth weight infants over 50 years 1st ventilated baby Staffing, equipment, NICU Surfactant exosurf AN Steroid trial 2 Neonatologists HFOV

  18. Survival of live-born inborn babies 2000-2010

  19. Grade 3-4 IVH in babies <1250g

  20. Retinopathy of prematurity

  21. MMH NWH Multiple pregnancy rate

  22. Multiple pregnancy rate MMH NWH

  23. Perinatal mortality of multiple pregnancies • New Zealand 2009 39 • NWH 2010 50 • MMH 2007 52

  24. Perinatal death and multiple birthNZ 2009 • Stillbirth rate 3 greater than that of singletons • Neonatal rate 7 greater • Perinatal rate 3.7 greater • One in 25 perinatal loss

  25. Perinatal Mortality of singletons and multiples in Queensland1995-2007 Queensland Maternal and Perinatal Quality Council. 2010

  26. Birth weight of singletons and multiples Pharoah POD, Clin Perinatol 2006;33:301– 313

  27. Multiple pregnancy rate over time Black M, Bhattacharya S. Seminars in Fetal & Neonatal Medicine 2010;15:306-312

  28. X X X X X X X 2010 Fertility PLUS X Percentage of multiple births in pregnancies conceived with and without the use of fertility techniques Queensland 1995-2007 Multiple births and fertility treatment

  29. Outlook for multiple pregnancies • Stillbirth rate 3 greater than that of singletons • Neonatal death rate 7 greater • Perinatal death rate 3.7 greater • One in 25 perinatal loss • Five time rate of cerebral palsy • 1% cerebral palsy • Six point reduction in IQ NZ perinatal and maternal mortality report 2009 Pharoah POD, Clin Perinatol 2006;33:301– 313 Cooke RWI, Seminars in Fetal & Neonatal Medicine 2010;15:362-366

  30. Long term outcome of VLBW infants at 2 years

  31. n = 42 33 55 44 51 57 59 39 46 50 51 39 41 40 46 41 46 47 Long term outcome of VLBW infants at 2 years

  32. Feeding at discharge of NICU babies

  33. Breast feeding at discharge in VLBW babiesNWH cf. 12 Italian units Davanzo R. Paediatr Perinat Epidemiol 2009;23:591–596.

  34. Breast feeding at discharge in VLBW babiesNWH cf. 12 Italian units Davanzo R. Paediatr Perinat Epidemiol 2009;23:591–596.

  35. Conclusion • Excellent report • Excellent results • Report clinical details of babies with long-term neurodisability Suggestions

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