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11.02.2018 Category: News

SwissNeoNet: a voice in favour of health care of preterm infants


Image: Professor Matthias Roth-Kleiner, President, Swiss Society of Neonatology (c) M. Roth-Kleiner

A guest article by Matthias Roth-Kleiner1, Hans-Ulrich Bucher2, Dirk Bassler3, Mark Adams4

President, Swiss Society of Neonatology
2 Founder of SwissNeoNet
3 President of the Steering committee of SwissNeoNet
4 Network coordinator, SwissNeoNet

Over the last four decades, the number of very low birth weight (VLBW) infants in Switzerland increased from 360 neonates with birth weight <1’500g in 1979 to > 880 VLBW infants in 2016 (www.bfs.admin.ch). Extraordinary development in perinatal care lead to a tremendous increase of survival for these tiny infants. However, the rising rate of survival coincides with an increased risk of survival with major handicap. In the early 1970’s, follow-up programs have been developed in many neonatal clinics in order to survey perinatal characteristics, the introduction of new treatment approaches and their effect on both quality of care and the long term outcome of these infants.

To standardize this quality control process on a national level, all nine clinics of the tertiary (highest) level of neonatal care jointly created the Swiss Neonatal Network (today called SwissNeoNet) in 1995. Relevant pre-, peri-, and postnatal parameters of all infants born before 32 0/7 weeks of gestational age (wGA) or with a birth weight of ?1'500 grams are collected in a central register. Since the year 2000, developmental data of all very preterm infants born before 28 0/7 wGA are prospectively collected according to a standardized follow-up program at the ages of 2 and 5-6 years. These neurodevelopmental examinations are performed by specially trained pediatricians in 16 centers all over Switzerland.

Of the about 80'000 live births per year in Switzerland, 260 are born between 22 – 27 wGA and 540 between 28 and 31 wGA. Of these, the centralized SwissNeoNet data base, the Minimal Neonatal Data Set (MNDS), covers 96% of all the pre-, peri-, and postnatal parameters of < 32wGA infants born in Switzerland. The rate of fully integrated data sets at 2 and 5 years lies at 87% and at 68%, respectively. Data entry is closely surveyed by a centralized analysis of data completeness and plausibility. Quality indicators have been defined and provide an in- depth epidemiological overview over mortality, morbidity and long term outcome of this high risk population born and treated for in Switzerland.

Twice a year, the directors of all neonatal clinics of the two highest levels of care meet to analyze and discuss standardized transversal and longitudinal quality indicator assessments in order to monitor the feared neonatal complications summarized as three letter diseases (NEC: necrotizing enterocolitis; BPD: bronchpulmonary dysplasia; ROP: retinopathy of the preterm; IVH: intraventricular hemorrhage; and sepsis) and the long term neurodevelopmental outcome. These efforts have led to numerous publications documenting the network’s quality, the integration of the national data into treatment guidelines and to several local quality improvement collaboratives ((1-6)).

Apart from sharing the best practices between benchmarking partners, the parameters collected by SwissNeoNet also allow us to compare Swiss national data with data bases of large international networks such as the Vermont Oxford Network. A forthcoming publication compares neonatal practices and outcome between Swiss NICUs and those of the United States (Adams et al. Pediatrics, accepted for publication).

In conclusion: The SwissNeoNet has become a leading tool for analysis, guidance and quality control of health care regarding VLBW and very preterm infants. Furthermore, it helps to unify Swiss neonatologists in their goal to apply best practice to newborn infants and to give an internationally renowned voice in favour of health care of the youngest and smallest patients of our society.




References: 

  1. Adams M, Braun J, Bucher HU, Puhan MA, Bassler D, Von Wyl V, et al. Comparison of three different methods for risk adjustment in neonatal medicine. BMC Pediatr. 2017;17(1):106.

  2. Adams M, Hoehre TC, Bucher HU, Swiss Neonatal N. The Swiss Neonatal Quality Cycle, a monitor for clinical performance and tool for quality improvement. BMC Pediatr. 2013;13:152.

  3. Berger TM, Steurer MA, Bucher HU, Fauchere JC, Adams M, Pfister RE, et al. Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period. BMJ Open. 2017;7(6):e015179.

  4. Hentschel J, Berger TM, Tschopp A, Muller M, Adams M, Bucher HU. Population-based study of bronchopulmonary dysplasia in very low birth weight infants in Switzerland. EurJPediatr. 2005;164(5):292-7.

  5. Ruegger C, Hegglin M, Adams M, Bucher HU, Swiss Neonatal N. Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years. BMC Pediatr. 2012;12:17.

  6. Schlapbach LJ, Aebischer M, Adams M, Natalucci G, Bonhoeffer J, Latzin P, et al. Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics. 2011;128(2):e348-57.

 
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