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Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016
INTRODUCTION: Perinatal management of extremely preterm births in Sweden has changed toward active care from 22–23 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a mo...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201972/ https://www.ncbi.nlm.nih.gov/pubmed/37212521 http://dx.doi.org/10.1111/aogs.14576 |
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author | Aronsson, Emma Holzmann, Malin Bartocci, Marco Hulthén Varli, Ingela Saltvedt, Sissel |
author_facet | Aronsson, Emma Holzmann, Malin Bartocci, Marco Hulthén Varli, Ingela Saltvedt, Sissel |
author_sort | Aronsson, Emma |
collection | PubMed |
description | INTRODUCTION: Perinatal management of extremely preterm births in Sweden has changed toward active care from 22–23 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a more active care between 2004–2007 and 2012–2016 and if this has influenced infant survival. MATERIAL AND METHODS: In this historical cohort study, women admitted with at least one live fetus and delivered at 22–25 gestational weeks (stillbirths included) at Karolinska University Hospital Solna during April 1, 2004–March 31, 2007, and January 1, 2012–December 31, 2016, were compared regarding rates of obstetric and neonatal interventions, and infant mortality and morbidity. Maternal, pregnancy and infant data from 2004–2007 were obtained from the Extreme Preterm Infants in Sweden Study while data from 2012–2016 were extracted from medical journals and quality registers. The same definitions of interventions and diagnoses were used for both study periods. RESULTS: A total of 106 women with 118 infants during 2004–2007 and 213 women with 240 infants during 2012–2016 were included. Increases between the study periods were seen regarding cesarean delivery (overall rate 14% [17/118] during 2004–2007 vs. 45% [109/240] during 2012–2016), attendance of a neonatologist at birth (62% [73/118] vs. 85% [205/240]) and surfactant treatment at birth in liveborn infants (60% [45/75] vs. 74% [157/211]). Antepartum stillbirth rate decreased (13% [15/118] vs. 5% [12/240]) and the proportion of live births increased (80% [94/118] vs. 88% [211/240]) while 1‐year survival (64% [60/94] vs. 67% [142/211]) and 1‐year survival without major neonatal morbidity (21% [20/94] vs. 21% [44/211]) among liveborn infants did not change between the study periods. At 22 gestational weeks, interventions rates were still low during 2012–2016, most obvious regarding antenatal steroid treatment (23%), attendance of a neonatologist (51%), and intubation at birth (24%). CONCLUSIONS: Both obstetric and neonatal interventions at births below 26 gestational weeks increased between 2004–2007 and 2012–2016 in this single center study; however, at 22 gestational weeks they were still at a low level during 2012–2016. Despite more infants being born alive, 1‐year survival did not increase between the study periods. |
format | Online Article Text |
id | pubmed-10201972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102019722023-05-23 Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 Aronsson, Emma Holzmann, Malin Bartocci, Marco Hulthén Varli, Ingela Saltvedt, Sissel Acta Obstet Gynecol Scand Pregnancy INTRODUCTION: Perinatal management of extremely preterm births in Sweden has changed toward active care from 22–23 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a more active care between 2004–2007 and 2012–2016 and if this has influenced infant survival. MATERIAL AND METHODS: In this historical cohort study, women admitted with at least one live fetus and delivered at 22–25 gestational weeks (stillbirths included) at Karolinska University Hospital Solna during April 1, 2004–March 31, 2007, and January 1, 2012–December 31, 2016, were compared regarding rates of obstetric and neonatal interventions, and infant mortality and morbidity. Maternal, pregnancy and infant data from 2004–2007 were obtained from the Extreme Preterm Infants in Sweden Study while data from 2012–2016 were extracted from medical journals and quality registers. The same definitions of interventions and diagnoses were used for both study periods. RESULTS: A total of 106 women with 118 infants during 2004–2007 and 213 women with 240 infants during 2012–2016 were included. Increases between the study periods were seen regarding cesarean delivery (overall rate 14% [17/118] during 2004–2007 vs. 45% [109/240] during 2012–2016), attendance of a neonatologist at birth (62% [73/118] vs. 85% [205/240]) and surfactant treatment at birth in liveborn infants (60% [45/75] vs. 74% [157/211]). Antepartum stillbirth rate decreased (13% [15/118] vs. 5% [12/240]) and the proportion of live births increased (80% [94/118] vs. 88% [211/240]) while 1‐year survival (64% [60/94] vs. 67% [142/211]) and 1‐year survival without major neonatal morbidity (21% [20/94] vs. 21% [44/211]) among liveborn infants did not change between the study periods. At 22 gestational weeks, interventions rates were still low during 2012–2016, most obvious regarding antenatal steroid treatment (23%), attendance of a neonatologist (51%), and intubation at birth (24%). CONCLUSIONS: Both obstetric and neonatal interventions at births below 26 gestational weeks increased between 2004–2007 and 2012–2016 in this single center study; however, at 22 gestational weeks they were still at a low level during 2012–2016. Despite more infants being born alive, 1‐year survival did not increase between the study periods. John Wiley and Sons Inc. 2023-05-22 /pmc/articles/PMC10201972/ /pubmed/37212521 http://dx.doi.org/10.1111/aogs.14576 Text en © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Pregnancy Aronsson, Emma Holzmann, Malin Bartocci, Marco Hulthén Varli, Ingela Saltvedt, Sissel Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 |
title | Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 |
title_full | Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 |
title_fullStr | Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 |
title_full_unstemmed | Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 |
title_short | Changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004–2007 and 2012–2016 |
title_sort | changes in perinatal management and outcomes of extremely preterm infants born below 26 weeks of gestation in a tertiary referral hospital in sweden: comparison between 2004–2007 and 2012–2016 |
topic | Pregnancy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201972/ https://www.ncbi.nlm.nih.gov/pubmed/37212521 http://dx.doi.org/10.1111/aogs.14576 |
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