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Obstetric and Neonatal Care Practices for Infants 501 to 1500 g From 2000 to 2009

OBJECTIVE: To identify changes in clinical practices for infants with birth weights of 501 to 1500 g born from 2000 to 2009. METHODS: We used prospectively collected registry data for 355 806 infants born from 2000 to 2009 and cared for at 669 North American hospitals in the Vermont Oxford Network. Main outcome measures included obstetric and neonatal practices, including cesarean delivery, antenatal steroids, delivery room interventions, respiratory practices, neuroimaging, retinal exams, and feeding at discharge. RESULTS: Significant changes in many obstetric, delivery room, and neonatal practices occurred from 2000 to 2009. Use of surfactant treatment in the delivery room increased overall (adjusted difference [AD] 17.0%; 95% confidence interval [CI] 16.4% to 17.6%), as did less-invasive methods of respiratory support, such as nasal continuous positive airway pressure (AD 9.9%; 95% CI 9.1% to 10.6%). Use of any ventilation (AD –7.5%; 95% CI –8.0% to –6.9%) and steroids for chronic lung disease (AD –15.3%; 95% CI –15.8% to –14.8%) decreased significantly overall. Most of the changes in respiratory care were observed within each of 4 birth weight strata (501–750 g, 751–1000 g, 1001–1250 g, 1251–1500 g). CONCLUSIONS: Many obstetric and neonatal care practices used in the management of infants 501 to 1500 g changed between 2000 and 2009. In particular, less-invasive approaches to respiratory support increased.