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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
Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden; Umea Univ Hosp, Sweden.
Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
Lund Univ, Sweden; Skane Univ Hosp, Sweden.
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2019 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 321, no 12, p. 1188-1199Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Chicago, IL, United States: American Medical Association , 2019. Vol. 321, no 12, p. 1188-1199
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:liu:diva-156571DOI: 10.1001/jama.2019.2021ISI: 000463074900015PubMedID: 30912837Scopus ID: 2-s2.0-85063324499OAI: oai:DiVA.org:liu-156571DiVA, id: diva2:1315850
Note

Funding Agencies|Swedish Order of Freemasons Foundation for Childrens Welfare; Swedish government (ministry of health and social affairs)

Available from: 2019-05-15 Created: 2019-05-15 Last updated: 2019-06-14Bibliographically approved

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Abrahamsson, ThomasGadsboll, Christian
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Division of Children's and Women's healthFaculty of Medicine and Health SciencesH.K.H. Kronprinsessan Victorias barn- och ungdomssjukhusDepartment of Clinical and Experimental Medicine
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Journal of the American Medical Association (JAMA)
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