Mikael Norman1,2,3, Boubou Hallberg1,2, Thomas Abrahamsson4, Lars J Björklund5, Magnus Domellöf6, Aijaz Farooqi6, Cathrine Foyn Bruun6, Christian Gadsbøll4,5, Lena Hellström-Westas7, Fredrik Ingemansson8, Karin Källén9, David Ley5, Karel Maršál10, Erik Normann7, Fredrik Serenius7, Olof Stephansson11,12, Lennart Stigson13, Petra Um-Bergström14,15, Stellan Håkansson3,6. 1. Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden. 2. Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden. 3. Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden. 4. Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden. 5. Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden. 6. Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden. 7. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 8. Department of Pediatrics, Ryhov County Hospital, Jönköping County Council, Jonkoping, Sweden. 9. Centre for Reproductive Epidemiology, Lund University, Lund, Sweden. 10. Departments of Clinical Sciences and Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden. 11. Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 12. Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 13. Department of Pediatrics, Institute for Clinical Sciences, Queen Silvia Children's Hospital, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. 14. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 15. Sachs' Children and Youth Hospital, Department of Neonatal Medicine, Södersjukhuset, Stockholm, Sweden.
Abstract
Importance: Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective: To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants: All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures: Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures: The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results: During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance: Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
Importance: Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective: To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants: All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures: Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures: The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results: During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance: Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
Authors: Johanne E Spreckels; Erik Wejryd; Giovanna Marchini; Baldvin Jonsson; Dylan H de Vries; Maria C Jenmalm; Eva Landberg; Eva Sverremark-Ekström; Magalí Martí; Thomas Abrahamsson Journal: Microorganisms Date: 2021-04-24
Authors: Khaleda Rahman Qazi; Georg B Jensen; Marieke van der Heiden; Sophia Björkander; Giovanna Marchini; Maria C Jenmalm; Thomas Abrahamsson; Eva Sverremark-Ekström Journal: Clin Transl Immunology Date: 2021-06-10