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.
Local Health Center Local Health Center Local Health Center Local Health Center Level II Hospital Intermediate Neonatal Care Level II Hospital Intermediate Neonatal Care Level III Hospital Neonatal Intensive Care Unit
Intensive care beds by center 5-13 >50 VLBW infants 10/21 Surgical centers Surgeries/year:2>70;1>40 Cardiac centers 2 south;1 center;1 north Public hospitals with perinatal care Level II-27 Level III-21 (including islands)
North Center South 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
Neonatal Mortality Portugal 2007/ VLBW Network < 32weeks 49% of neonatal mortality VLBW Network Neonatal Society
Portuguese VLBW Infants Network 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 Main Goals
Methods VLBW infants gr ( ); gr (>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 Portuguese VLBW Network
n % Portuguese VLBW database The Portuguese VLBW Network VLBW Prevalence (%)
European Perinatal Health Report,2008
Portuguese VLBW Infants Network Regionalization Nº = 3561 REGISTO NACIONAL DO GRANDE PREMATURO Secção de Neonatologia - SPP
Place of delivery – 10 years evolution In uterus transport 176 (21%)374 (37%)P<0.001 Birth in level III678 (82%)920 (92%)P<0.001 Neonatal transport 124 (15%)79 (8%)P<0.001 In born706( 85%)921 (92%)P<0.001
Portuguese VLBW Network 15% 9% Effectiveness of regionalization. It worthes to avoid neonatal transport.
The Portuguese VLBW Network VLBW n=5034 VLBW 2004 n=1016 nDeaths% IN OUT P<0.001 nDeaths% IN OUT P<0.001 It worthes to be born in the right place.
Portuguese VLBW Network Evolution of mortality per BW Improving the efficiency in ELBW
Portuguese VLBW Infants Network Perinatal data 23 Nº = 3561 REGISTO NACIONAL DO GRANDE PREMATURO Secção de Neonatologia - SPP
85 % % 8,5 8% 4.9% EuroNeoNet 2007
Threshold of Viability Birth Weight Nº = 3561 REGISTO NACIONAL DO GRANDE PREMATURO Secção de Neonatologia - SPP n = 3561
Nº = 3561 REGISTO NACIONAL DO GRANDE PREMATURO Secção de Neonatologia - SPP Threshold of Viability (GA) n = 3561
Portuguese VLBW Network Threshold of viability >50% alive 1996 – 27 w 1997 – 26 w >2004 – 25 w Threshold of survival without major sequelae 1996 – 29 w 1997 – 28 w >2004 – 27 w 22 w GA: no survivors 23 w GA: rare 24 w: survival rate - 38 %
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
Portuguese VLBW Infants Network 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 The next years objectives