1. Newborn Services Annual Clinical Report, 2010 Commentary by Dr David Knight Director of Neonatology Mater Mothers’ Hospital Brisbane Australia

2. Mater Mothers’ Hospital New hospital opened in 2008 9500 births a year 79 cot newborn nursery –37 ICU (= CPAP or more) 1700 admissions 271 VLBW infants –(NWH 176)

3. “MMH” In this presentation MMH refers to Mater Mothers’ Hospital NOT Middlemore Hospital

4. Assessing the Newborn Service Acuity and workload –Admission rate –Very low birth weight admissions –Occupancy –Assisted ventilation Results and quality –Antenatal steroids –Hypoxic ischaemic encephalopathy –Survival –Intraventricular haemorrhage –Retinopathy of prematurity –Multiple pregnancies –Long term outcome –Breast feeding

5. Admission rate of inborn babies

6. Very low birth weight births 1959-2010 Outborn numbers 2000-4 to 2006-10 increased average of 19→33 Ross HowieDavid KnightMB

7. Very low birth weight births 1959-2010 Outborn numbers 2000-4 to 2006-10 increased average of 19→33

8. NICU occupancy 2000-2010

9. 32-6 weeks 28-31 weeks <28 weeks Term/post-term

10. Number of babies having assisted ventilation 86% increase from 2009 Error 68 outborn 32 term 25 <32 wks Table 78, page 135

11. Number of babies having assisted ventilation Is there an error in the previous data (table 78)? Data from table 78 Figure 97: inborn babies

12. Percentage on IPPV Percentage on CPAP Ventilation in 24-7 week infants X X X X X X X X HFOV use in babies <28 weeks X MMH X

13. Ventilation in 28-31 week babies X MMH X X X X

14. Assessing the Newborn Service Acuity and workload –Admission rate –Very low birth weight admissions –Occupancy –Assisted ventilation Results and quality –Antenatal steroids –Hypoxic ischaemic encephalopathy –Survival –Intraventricular haemorrhage –Retinopathy of prematurity –Multiple pregnancies –Long term outcome –Breast feeding

15. Antenatal corticosteroid use 24-27 weeks 28-31 weeks X X

16. Hypoxic ischaemic encephalopathy 5 inborn babies in 2010 –2 placental abruptions –3 fetal distress 9 outborn –4 Waitakere –4 North Shore Stage 2-3 HIE in inborn babies

17. Survival to 28 days of very low birth weight infants over 50 years 1 st ventilated baby AN Steroid trial 2 Neonatologists Staffing, equipment, NICU Surfactant exosurf HFOV

18. Survival of live-born inborn babies 2000-2010

19. Grade 3-4 IVH in babies <1250g

20. Retinopathy of prematurity

21. Multiple pregnancy rate NWH MMH

22. Multiple pregnancy rate NWH MMH

23. Perinatal mortality of multiple pregnancies New Zealand 200939 NWH 201050 MMH 200752

24. Perinatal death and multiple birth NZ 2009 Stillbirth rate 3 greater than that of singletons Neonatal rate 7 greater Perinatal rate 3.7 greater One in 25 perinatal loss BirthsTOPStillbirthNeonatalPerinatal Singleton618622.162.410.5 Multiple18033.317.818.138.8

25. Perinatal Mortality of singletons and multiples in Queensland 1995-2007 Queensland Maternal and Perinatal Quality Council. 2010

26. Birth weight of singletons and multiples Pharoah POD, Clin Perinatol 2006;33:301– 313

27. Multiple pregnancy rate over time Black M, Bhattacharya S. Seminars in Fetal & Neonatal Medicine 2010;15:306-312

28. Multiple births and fertility treatment Percentage of multiple births in pregnancies conceived with and without the use of fertility techniques Queensland 1995-2007 X X X X X X 2010 X X Fertility PLUS

29. Outlook for multiple pregnancies Stillbirth rate 3 greater than that of singletons Neonatal death rate 7 greater Perinatal death rate 3.7 greater One in 25 perinatal loss Five time rate of cerebral palsy 1% cerebral palsy Six point reduction in IQ NZ perinatal and maternal mortality report 2009 Pharoah POD, Clin Perinatol 2006;33:301– 313 Cooke RWI, Seminars in Fetal & Neonatal Medicine 2010;15:362-366

30. Long term outcome of VLBW infants at 2 years Survivors from 2008 n = 143 Without congenital anomaly n = 139 Seen at CDU n = 111 (80%) Assessed elsewhere n = 16 (16%) Lost to follow-up n = 12 (9%)

31. Long term outcome of VLBW infants at 2 years n = 42 33 55 44 51 57 59 39 46 50 51 39 41 40 46 41 46 47

32. Feeding at discharge of NICU babies

33. Breast feeding at discharge in VLBW babies NWH cf. 12 Italian units Davanzo R. Paediatr Perinat Epidemiol 2009;23:591–596.

34. Breast feeding at discharge in VLBW babies NWH cf. 12 Italian units Davanzo R. Paediatr Perinat Epidemiol 2009;23:591–596.

35. Conclusion Excellent report Excellent results Report clinical details of babies with long- term neurodisability Suggestions