Fredrik Serenius1, Mats Blennow2, Karel Maršál3, Gunnar Sjörs4, Karin Källen5. 1. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden; fredrik.serenius@kbh.uu.se. 2. Department of Pediatrics, Karolinska University Hospital, Huddinge, Stockholm, Sweden; 3. Department of Obstetrics and Gynecology, Lund University, Lund, Sweden; 4. Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden; and. 5. Centre for Reproductive Epidemiology, Lund University, Lund, Sweden.
Abstract
OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (<27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. RESULTS: Each 5-point increment in GA-specific activity score reduced the stillbirth risk (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) and the 1-year mortality risk (aOR: 0.84; 95% CI: 0.78-0.91) in the primary population and the 1-year mortality risk in live-born infants (aOR: 0.86; 95% CI: 0.79-0.93). In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22- to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA. CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.
OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (<27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. RESULTS: Each 5-point increment in GA-specific activity score reduced the stillbirth risk (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) and the 1-year mortality risk (aOR: 0.84; 95% CI: 0.78-0.91) in the primary population and the 1-year mortality risk in live-born infants (aOR: 0.86; 95% CI: 0.79-0.93). In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22- to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA. CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.
Authors: Noelle Younge; Ricki F Goldstein; Carla M Bann; Susan R Hintz; Ravi M Patel; P Brian Smith; Edward F Bell; Matthew A Rysavy; Andrea F Duncan; Betty R Vohr; Abhik Das; Ronald N Goldberg; Rosemary D Higgins; C Michael Cotten Journal: N Engl J Med Date: 2017-02-16 Impact factor: 91.245
Authors: Andrei S Morgan; Jennifer Zeitlin; Karin Källén; Elizabeth S Draper; Karel Maršál; Mikael Norman; Fredrik Serenius; Stef van Buuren; Samantha Johnson; Valérie Benhammou; Véronique Pierrat; Monique Kaminski; Laurence Foix L'Helias; Pierre-Yves Ancel; Neil Marlow Journal: Acta Paediatr Date: 2021-09-12 Impact factor: 4.056
Authors: Noelle Younge; P Brian Smith; Kathryn E Gustafson; William Malcolm; Patricia Ashley; C Michael Cotten; Ronald N Goldberg; Ricki F Goldstein Journal: Early Hum Dev Date: 2016-02-19 Impact factor: 2.699