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Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016

Artikel i vetenskaplig tidskrift
Författare M. Norman
B. Hallberg
T. Abrahamsson
L. J. Bjorklund
M. Domellof
A. Farooqi
C. F. Bruun
C. Gadsboll
L. Hellstrom-Westas
F. Ingemansson
K. Kallen
D. Ley
K. Marsal
E. Normann
F. Serenius
O. Stephansson
Lennart Stigson
P. Um-Bergstrom
S. Hakansson
Publicerad i Jama-Journal of the American Medical Association
Volym 321
Nummer/häfte 12
Sidor 1188-1199
ISSN 0098-7484
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för pediatrik
Sidor 1188-1199
Språk en
Länkar dx.doi.org/10.1001/jama.2019.2021
Ämnesord active perinatal-care, cognitive outcomes, weeks gestation, children, born, risk-factors, metaanalysis, prematurity, retinopathy, morbidity
Ämneskategorier Pediatrik

Sammanfattning

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 22-26weeks' 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 outcomewas 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.

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