Since 2004Since -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.

(Abstracted from JAMA 2019;321(12):1188–1199) The long-term health outcomes for preterm infants have improved over time, but infants born at extreme preterm gestational ages continue to present issues of optimal antenatal and postnatal management, resource allocation and costs, quality of care, and long-term health outcomes. To better understand variations and time trends for management and outcomes of extremely preterm birth, study of international populations is needed.

AimThis Swedish study compared reading skills between seven‐year‐old children with a very low birthweight (VLBW) and controls with a normal birthweight, exploring associations between reading variables and cognition, parent‐rated behaviour, perinatal factors and family factors.MethodsWe studied 51 VLBW children, with no major neurodevelopmental impairments and attending their first year at a regular school, and compared them with the 51 sex‐ and age‐matched controls. The test battery, carried out at 7.8 ± 0.4 years of age, included reading skills, the Wechsler Intelligence Scale for Children – III and the Child Behaviour Checklist.ResultsVery low birthweight children with a mean birthweight of 1105 g (±291 g) and a gestational age of 28.8 (±2.2) weeks scored significantly lower in all reading subtests and cognition and demonstrated more behavioural problems than normal birthweight controls. We also found significant associations between poor vocabulary, combined with attention problems, and phonological awareness, rapid naming and spelling control. Perinatal factors had no association with reading function, and socio‐economic factors had very few.ConclusionVery low birthweight children demonstrated deficits in all reading domains and had poorer cognition and more behavioural problems at the age of seven, with reading ability related to vocabulary and attention.

Background. There are still diverging results concerning the behaviour of children with very-low-birth-weight (VLBW) and they have been questioned to display different levels of stress hormone than normal-birth-weight (NBW) children. Aims. This study examined behaviour and the stress hormone cortisol in children with VLBW at the ages of 7 and 9 years compared with children with NBW. Results. Fifty-one VLBW and 50 NBW children were studied with the Child Behavior Checklist. Cortisol rhythm was measured through saliva samples three times a day for 2 days. VLBW children displayed more behavioural problems than NBW children, specifically social and attention problems, although still within normal ranges. They showed lower cortisol levels both at 7 and 9 years of age. No strong association between behaviour and cortisol levels was shown. Conclusion. VLBW children display more behaviour problems compared with NBW children but both groups score are within the normal range. Down-regulation of their hypothalamic-pituitary-adrenal (HPA) function in terms of lower cortisol levels is also noted.

Background Early-onset sepsis (EOS) is a potentially life-threatening complication of birth. Clinical symptoms are often unspecific and biomarkers have low predictive values for EOS. Therefore, clinical suspicion often leads to antibiotic therapy in neonates with a negative blood culture. In the study we evaluated if a quality improvement initiative could reduce unwarranted antibiotic use in a safe way in term neonates with culture-negative sepsis. Methods The quality improvement initiative included new treatment guidelines and were introduced on 11 June 2018. The guidelines included C-reactive protein- and clinical symptoms-guided decision-making and shorter intravenous antibiotic therapy. All term neonates treated for EOS at Ryhov Hospital, Jönköping, Sweden were studied before (period 1: 2016–2017) and after the introduction of the new guidelines (period 2: 11 June 2018 to 30 Sept 2019). Laboratory and clinical data were analysed. Results There were 7618 term neonates in period 1 and 5005 term neonates in period 2. We identified 140 (1.8%) EOS in period 1 and 97 (1.9%) EOS in period 2. During period 1 and 2, there were 61 (61/140, 44%) and 59 (59/97, 61%) EOS neonates, respectively, who met the criteria for shorter antibiotic treatment. The number of positive blood cultures were seven (0.92/1000 live births) and five (1.0/1000 live births) in period 1 and 2. The median C-reactive protein were 52 mg/L (37–62) in period 1 and 42 mg/L (31–56) in period 2 in the group who met the criteria of the guidelines. The duration of antibiotic therapy (Median: seven vs. five days, p < 0.001) and hospital stay (Median: seven vs. five days, p < 0.001) as well as healthcare costs (decreased by €122,000/year) was reduced in the group who met the criteria after the introduction of the guidelines. Conclusion C-reactive protein- and clinical symptoms-guided decision-making for EOS significantly decreased the duration of antibiotic therapy and hospital stay, and hence reduced healthcare costs, with no reinfection in a cohort of term infants. Trial registration Trial registration number: ISRCTN29535824. Date of registration: 28 May 2020. Retrospectively registered.

Very low birthweight children demonstrated worse reading performance at eight years of age than term-born controls. The gap in reading skills between the groups had largely narrowed two years later.

Aim Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis. Methods Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case‐mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (<32 weeks) and extremely preterm infants (<28 weeks of gestational age) were compared. Results Out of 287 642 infants born alive, 16 567 (5.8%) were preterm, 2389 (0.83%) very preterm and 800 (0.28%) were extremely preterm. In very preterm infants, exposure to antenatal corticosteroids varied from 85% to 98%, live births occurring at regional centres from 48% to 100%, surfactant treatment from 28% to 69% and use of mechanical ventilation varied from 13% to 77% (p < 0.05 for all comparisons). Significant regional variations within and between countries were also seen in capacity in neonatal care, case‐mix and number of admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities. Conclusion Management of very preterm infants exhibited significant regional variations in the Nordic countries.

(JAMA. 2019;321(12):1188–1199) Since 2004-2007, Sweden has created new recommendations, regulations and laws concerning extremely preterm births. In 2008, it became mandatory to register all stillbirths at 22 to 27 weeks’ gestational age to record statistics for all extremely preterm births. The withholding or withdrawal of advanced life support was the subject of regulations issued in 2011. In 2016, national guidelines for perinatal management were published and included recommendations on the resuscitation of infants delivered between 22 and 24 weeks gestation, the use of antenatal corticosteroid treatment, mode of delivery, and centralization of care. It’s unclear if these actions had significant effects on outcomes for extremely preterm infants in Sweden. This study aimed to compare the survival rates of extremely preterm infants born in 2004-2007 with those born between 2014 and 2016.