Carl H Backes1,2,3, Fanny Söderström4, Johan Ågren4, Richard Sindelar4, Christopher W Bartlett5, Brian K Rivera6, Courtney C Mitchell6, Heather A Frey7, Edward G Shepherd6,8, Leif D Nelin6,8, Erik Normann4. 1. Departments of Pediatrics and Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. carl.backes@nationwidechildrens.org. 2. The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA. carl.backes@nationwidechildrens.org. 3. The Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. carl.backes@nationwidechildrens.org. 4. Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden. 5. Battelle Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, OH, USA. 6. The Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 7. Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 8. Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Abstract
OBJECTIVE: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation. STUDY DESIGN: Retrospective, cohort study (2006-2015). Enrollment was limited to mother-infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother-infant dyads (comprehensive center); the other center (Nationwide Children's Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated. RESULT: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05). CONCLUSION: Even when mother-infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
OBJECTIVE: To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation. STUDY DESIGN: Retrospective, cohort study (2006-2015). Enrollment was limited to mother-infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother-infant dyads (comprehensive center); the other center (Nationwide Children's Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated. RESULT: Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05). CONCLUSION: Even when mother-infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
Authors: Richard Sindelar; Edward G Shepherd; Johan Ågren; Howard B Panitch; Steven H Abman; Leif D Nelin Journal: Pediatr Res Date: 2021-05-19 Impact factor: 3.756
Authors: Matthew A Rysavy; Katrin Mehler; André Oberthür; Johan Ågren; Satoshi Kusuda; Patrick J McNamara; Regan E Giesinger; Angela Kribs; Erik Normann; Susan J Carlson; Jonathan M Klein; Carl H Backes; Edward F Bell Journal: J Pediatr Date: 2021-03-07 Impact factor: 6.314
Authors: Pia Lundgren; Eva Morsing; Anna-Lena Hård; Alexander Rakow; Lena Hellström-Westas; Lena Jacobson; Mats Johnson; Gerd Holmström; Staffan Nilsson; Lois E Smith; Karin Sävman; Ann Hellström Journal: Acta Paediatr Date: 2022-04-12 Impact factor: 4.056