Background and Aim Cranial ultrasound (CUS) routine screening examinations have been routinely performed in preterm neonates for decades. The aim of this study is to explore changes over time in the occurrence of severe neonatal brain injury as a function of neonate characteristics and clinical practice features.
Methods Inborn neonates from a single centre (Hosp 12 Octubre, Madrid) in years 1991–2010 with birthweight (BW) <1500g entered a CUS protocol. Brain injury was defined after its full evolution. Three types of severe brain lesions were described: intraventricular haemorrhage (IVH) grade III, parenchymal lesion (PL) III-IV, and ventriculomegaly III. Time trends for brain injuries, neonate characteristics and clinical practice features were explored with generalized estimation equations for logistic regression.
Results 1574 neonates were included in the 20 year study period; 1298 (82.5%) survived the NICU, 33% BW <1000g. From 1991–2006, severe IVH was in the range 4–6% overall; between 3–4% in survivors and 17–31% in non-survivors, odds ratio 7(4–11). Severe parenchymal lesions dropped from 8–9% to 3–4% overall after year 1998, OR 0.35(0.14–0.85); it was much higher in non-survivors (initially, 40%) than in survivors (down to 3% in 1999–2006, OR 5(3–8)). In the last 4 year period, a significant increase in severe HIV/PL was documented, particularly in BW <1000g, parallel to a further survival increase.
Conclusion No different time trends for severe brain injury were observed in survivors and non-survivors. Variations in characteristics (e.g. increased survival at lower gestational age) may be related with changes in neonatal brain injury outcomes over time.