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10 millions inhabitants 100000 births / year Universal National Healthcare

Neonatal Mortality of VLBW in Europe The Portuguese Experience Portuguese VLBW Infants Network Hercília Guimarães herciliaguimaraes@gmail.com Brussels, December 2009. 10 millions inhabitants 100000 births / year Universal National Healthcare.

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10 millions inhabitants 100000 births / year Universal National Healthcare

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  1. Neonatal Mortality of VLBW in EuropeThe Portuguese ExperiencePortuguese VLBW Infants NetworkHercília Guimarãesherciliaguimaraes@gmail.com Brussels, December 2009

  2. 10 millions inhabitants • 100000 births / year • Universal National Healthcare

  3. Perinatal, late fetal and early neonatal mortality rate, Portugal 1980-2005 Perinatal Care System VLBW Register Early neonatal Perinatal Late Fetal

  4. Perinatal, neonatal and infant mortality evolution

  5. Portuguese Perinatal Healthcare Policy National Committee for mother and child healthcare (1989) • Maternities with < 1500 deliveries/year were closed • Hospitals were classified as Level II and Level III • Functional Coordinating Units connect the Hospitals to the Primary Healthcare Centers • The post graduation of Paediatricians in Neonatology originated the creation of the Special Studies on Neonatology Cycle. • Transport in utero was recognized as the best • Neonatal transport – INEM, was created as an alternative.

  6. Local Health Center Level II Hospital Intermediate Neonatal Care Local Health Center Level III Hospital Neonatal Intensive Care Unit Local Health Center Level II Hospital Intermediate Neonatal Care Local Health Center

  7. Public hospitals with perinatal care Level II-27 Level III-21 (including islands)

  8. National Neonatal Transport • 3 centers placed in level 3 hospitals • Centralized information system • Ambulance equipped with a NICU, and nurse and doctor with expertise in neonatal transport North Center South

  9. Neonatal MortalityPortugal 2007/ VLBW Network < 32weeks 49% of neonatal mortality VLBW Network 1994-2009 Neonatal Society

  10. Portuguese VLBW Infants Network - 1994 Main Goals • To consolidate a Network of multicenter prospective neonatal studies • To integrate clinical research in activities of assistence • To determine the prevalence of VLBW in Portugal and the contribution in the mortality and morbidity • To analyse the efficiency of neonatal regionalization • To monitor clinical practices in order to have a national standard for the self-assessement

  11. Portuguese VLBW Network Methods VLBW infants 500-1499gr (1994-98); 401-1499gr (>1998) • Central Coordination – Coimbra • Data Base on line: htpp//downloads.lusoneonatologia.net • National Meetings (objectives and methods) • Integration in clinical practice – Registration Form • Collective and voluntary participation

  12. VLBW infants - Portuguese Network Participating NICU´s

  13. VLBW National NetworkCover rate 100%

  14. The Portuguese VLBW Network VLBW Prevalence (%) n % Portuguese VLBW database 1994 - 2004

  15. European Perinatal Health Report,2008

  16. Portuguese VLBW Infants NetworkRegionalization Nº = 3561 2005-2008 17 REGISTO NACIONAL DO GRANDE PREMATURO 1994-2009 Secção de Neonatologia - SPP

  17. Place of delivery – 10 years evolution

  18. Portuguese VLBW Network It worthes to avoid neonatal transport. 15% 9% Effectiveness of regionalization.

  19. Europeristat 2008

  20. The Portuguese VLBW Network VLBW 2000-2004 n=5034 VLBW 2004 n=1016 It worthes to be born in the right place. P<0.001 P<0.001

  21. Portuguese VLBW Network Evolution of mortality per BW Improving the efficiency in ELBW

  22. Portuguese VLBW Infants NetworkPerinatal data Nº = 3561 23 REGISTO NACIONAL DO GRANDE PREMATURO 1994-2009 Secção de Neonatologia - SPP

  23. 85 % 85 % 6.5 21% 8,5 8% 4.9% EuroNeoNet 2007

  24. Threshold of Viability Birth Weight 2005-2008 Nº = 3561 2005-2008 n = 3561 25 REGISTO NACIONAL DO GRANDE PREMATURO 1994-2009 Secção de Neonatologia - SPP

  25. Threshold of Viability (GA) 2005-2008 Nº = 3561 2005-2008 n = 3561 26 REGISTO NACIONAL DO GRANDE PREMATURO 1994-2009 Secção de Neonatologia - SPP

  26. Portuguese VLBW Network 22 w GA: no survivors 23 w GA: rare 24 w: survival rate - 38 % Threshold of survival without major sequelae • 1996 – 29 w • 1997 – 28 w • >2004 – 27 w Threshold of viability >50% alive 1996 – 27 w 1997 – 26 w >2004 – 25 w

  27. Portuguese VLBW NetworkMorbidity

  28. 53,8% 9% 65% 42% 19% 2.4 1.7 1.1 2.7 36% 92% 8,7% 4,2% 4,1% 20,8% 5,6 % 61,5% 24,7% 3,7% EuroNeoNet 2007

  29. Portuguese VLBW Network • The aims of regionalisation were achieved. • The perinatal care reform in Portugal is an example of how a good diagnosis and adequate proposals combined with a strong political will is important for changing . Conclusions

  30. Portuguese VLBW Infants Network The next years objectives • To keep the benefits of organizational measures • To improve Follow-up of VLBW infants at 36 m and 5 years • To promote self-evaluation of NICU´s (Quality) • To improve Network of Neonatal Research

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