5 Perinatal, neonatal and infant mortality evolution 19951996199719981999200020012002200320042005200620072008InfantMortality(‰)184.108.40.206.05.65.55.04.220.127.116.11.4Perinatal9.08.47.26.18.104.22.168.34.64.0Neonatal mortality22.214.171.124.126.96.36.199.22.82.02.1Foetal morality188.8.131.52
6 Portuguese Perinatal Healthcare Policy National Committee for mother and child healthcare (1989) Maternities with < 1500 deliveries/year were closedHospitals were classified as Level II and Level IIIFunctional Coordinating Units connect the Hospitals to the Primary Healthcare CentersThe post graduation of Paediatricians in Neonatology originated the creation of the Special Studies on Neonatology Cycle.Transport in utero was recognized as the bestNeonatal transport – INEM, was created as an alternative.
7 Intermediate Neonatal Care Local HealthCenterLevel II HospitalIntermediate Neonatal CareLocal HealthCenterLevel III HospitalNeonatal Intensive Care UnitLocal HealthCenterLevel II HospitalIntermediate Neonatal CareLocal HealthCenter7
8 Level II-27 Level III-21 (including islands) Public hospitals with perinatal careLevel II-27 Level III-21 (including islands)Intensive care beds by center5-13>50 VLBW infants10/21Surgical centersSurgeries/year:2>70;1>40Cardiac centers2 south;1 center;1 north8
9 National Neonatal Transport 3 centers placed in level 3 hospitalsCentralized information systemAmbulance equipped with a NICU, and nurse and doctor with expertise in neonatal transportNorthCenterSouth
10 Neonatal Mortality Portugal 2007/ VLBW Network < 32weeks49% of neonatal mortalityVLBW NetworkNeonatal Society10
11 Portuguese VLBW Infants Network - 1994 Main GoalsTo consolidate a Network of multicenter prospective neonatal studiesTo integrate clinical research in activities of assistenceTo determine the prevalence of VLBW in Portugal and the contribution in the mortality and morbidityTo analyse the efficiency of neonatal regionalizationTo monitor clinical practices in order to have a national standard for the self-assessement
12 Portuguese VLBW Network MethodsVLBW infants gr ( ); gr (>1998)Central Coordination – CoimbraData Base on line: htpp//downloads.lusoneonatologia.netNational Meetings (objectives and methods)Integration in clinical practice – Registration FormCollective and voluntary participation
13 VLBW infants - Portuguese Network Participating NICU´s A incidência em 1994 foi 0,66%. Dois anos depois passou para 0,81, atingindo o 1% em Os reflexos na mortalidade fetal foram notórios. A reanimação de fetos no limite da viabilidade aumentou verificando-se uma estagnação nos últimos anos.
30 Portuguese VLBW Network ConclusionsThe 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 .
31 Portuguese VLBW Infants Network The next years objectivesTo keep the benefits of organizational measuresTo improve Follow-up of VLBW infants at 36 m and 5 yearsTo promote self-evaluation of NICU´s (Quality)To improve Network of Neonatal Research