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One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden

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Author

  • Mats Blennow
  • Uwe Ewald
  • Tomas Fritz
  • Per Ake Holmgren
  • Annika Jeppsson
  • Eva Lindberg
  • Anita Lundqvist
  • Solveig Norden Lindeberg
  • Elisabeth Olhager
  • Ingrid Ostlund
  • Marija Simic
  • Gunnar Sjoers
  • Lennart Stigson
  • Vineta Fellman
  • Lena Hellström-Westas
  • Mikael Norman
  • Magnus Westgren
  • Gerd Holmstrom
  • Ricardo Laurini
  • Karin Stjernqvist
  • Karin Källén
  • Hugo Lagercrantz
  • Karel Marsal
  • Fredrik Serenius
  • Margareta Wennergren
  • Tore Nilstun
  • Petra Otterblad Olausson
  • Bo Stromberg
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Summary, in English

Context Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling. Objective To determine the 1-year survival in all infants born before 27 gestational weeks in Sweden during 2004-2007. Design, Setting, and Patients Population-based prospective observational study of extremely preterm infants (707 live-born and 304 stillbirths) born to 887 mothers in 904 deliveries (102 multiple births) in all obstetric and neonatal units in Sweden from April 1, 2004, to March 31, 2007. Main Outcome Measures Infant survival to 365 days and survival without major neonatal morbidity (intraventricular hemorrhage grade > 2, retinopathy of prematurity stage > 2, periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia). Associations between perinatal interventions and survival. Results The incidence of extreme prematurity was 3.3 per 1000 infants. Overall perinatal mortality was 45% (from 93% at 22 weeks to 24% at 26 weeks), with 30% stillbirths, including 6.5% intrapartum deaths. Of live-born infants, 91% were admitted to neonatal intensive care and 70% survived to 1 year of age (95% confidence interval [CI], 67%-73%). The Kaplan-Meier survival estimates for 22, 23, 24, 25, and 26 weeks were 9.8% (95% CI, 4%-23%), 53% ( 95% CI, 44%-63%), 67% (95% CI, 59%-75%), 82% (95% CI, 76%-87%), and 85% ( 95% CI, 81%-90%), respectively. Lower risk of infant death was associated with tocolytic treatment (adjusted for gestational age odds ratio [ OR], 0.43; 95% CI, 0.36-0.52), antenatal corticosteroids (OR, 0.44; 95% CI, 0.24-0.81), surfactant treatment within 2 hours after birth ( OR, 0.47; 95% CI, 0.32-0.71), and birth at a level III hospital (OR, 0.49; 95% CI, 0.32-0.75). Among 1-year survivors, 45% had no major neonatal morbidity. Conclusion During 2004 to 2007, 1-year survival of infants born alive at 22 to 26 weeks of gestation in Sweden was 70% and ranged from 9.8% at 22 weeks to 85% at 26 weeks. JAMA. 2009;301(21):2225-2233 www.jama.com

Publishing year

2009

Language

English

Pages

2225-2233

Publication/Series

JAMA: The Journal of the American Medical Association

Volume

301

Issue

21

Document type

Journal article

Publisher

American Medical Association

Topic

  • Obstetrics, Gynecology and Reproductive Medicine

Status

Published

Research group

  • Tornblad Institute

ISBN/ISSN/Other

  • ISSN: 1538-3598