PROACTIVE APPROACH TO resuscitation and intensive care of extremely preterm infants (Ͻ27 gestational weeks) has increased survival and lowered the gestational age of viability. 1-4 There are concerns that increased survival may come at the cost of later neurodevelopmental disability among survivors. Approximately 25% of extremely preterm infants born in the 1990s had a major disability at preschool age, such as impaired mental development, cerebral palsy (CP), blindness, or deafness. 5,6 More recent studies report decreasing, 7,8 unchanged, 2 or increasing rates of neurodevelopmental disability 9-11 at preschool age compared with previous decades. The most immature infants, ie, those born before 25 weeks Author Affiliations and Members of the EXPRESS Group appear at the end of this article.

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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 Ͼ2, retinopathy of prematurity stage Ͼ2, 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.

Aims: To determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotising enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥ 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusions: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted. Background and aims: Autism spectrum disorders (ASDs) are disorders of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. Previous studies investigating neonatal factors and ASDs have produced inconsistent results. We performed confirmatory analyses concerning various neonatal complications and a later diagnosis with ASDs, and infantile autism, specifically. Methods: A Danish population based cohort study, including all children born in Denmark from 1994, through 2002, a total of 604,140 children. Diagnoses of neonatal complications were retrieved from the Danish National Hospital Register. Children diagnosed with ASDs were identified using the Danish Psychiatric Central Register. Data was analyzed using Cox proportional hazards regression. Results: A total of 4,145 children were diagnosed with ASDs, of which 1,493 had infantile autism. We found an increased risk of ASDs after exposure to a variety of neonatal complications; respiratory distress: adjusted hazard ratio (HR)=1.24 [95% confidence interval (CI): 1.02-1.51], intracranial bleeding, cerebral edema or seizures: HR=1.94 [95% CI: 1.12-3.36], neonatal hypoglycemia: HR=1.46

AimThe aim of this study was to investigate differences in mortality up to 1 year of age in extremely preterm infants (before 27 weeks) born in seven Swedish healthcare regions.MethodsNational prospective observational study of consecutively born, extremely preterm infants in Sweden 2004–2007. Mortality was compared between regions. Crude and adjusted odds ratios and 95% CI were calculated.ResultsAmong 844 foetuses alive at mother's admission for delivery, regional differences were identified in perinatal mortality for the total group (22–26 weeks) and in the stillbirth and perinatal and 365-day mortality rates for the subgroup born at 22–24 weeks. Among 707 infants born alive, regional differences were found both in mortality before 12 h and in the 365-day mortality rate for the subgroup (22–24 weeks) and for the total group (22–26 weeks). The mortality rates were consistently lower in two healthcare regions. There were no differences in the 365-day mortality rate for infants alive at 12 h or for infants born at 25 weeks. Neonatal morbidity rates among survivors were not higher in regions with better survival rates. Perinatal practices varied between regions.ConclusionMortality rates in extremely preterm infants varied considerably between Swedish healthcare regions in the first year after birth, particularly between the most immature infants.