Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

Abstract

, for the EXPRESS Study Group abstract OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (,27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22-to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA.CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

Recent Declines in Infant and Neonatal Mortality in Turkey from 2007 to 2012: Impact of Improvements in Health Policies

“…Under-5 mortality (U5MR) in Turkey fell sharply from 72.0 per 1,000 live births in 1990 to 15.0 in 2011, and IMR fell from 60.0 in 1990 to 12.0 in 2011 (1). Despite small differences, these values were similar to those from the Ministry of Health of Turkey, which were 77.2 per 1,000 live births in 1988, 26.0 in 1998, and 10.1 in 2010 (2). The reductions in IMR and NMR achieved by Turkey from 1990-2010 were greater than those achieved by other E7 countries (China, India, Brazil, Mexico, Russia, Indonesia, Turkey) (3).…”

“…Recent estimates of preterm birth rates (all live births before 37 completed weeks) for 184 countries in 2010 and a time series for 65 countries with sufficient data suggest that the rate of preterm birth may reach 14.9 million (25). A recent study from Sweden showed that proactive perinatal care decreased mortality without increasing the risk of neurodevelopmental impairment at 2.5 years of corrected age in extremely preterm infants (26). Premature birth rate is about 11-12% in Turkey (7,16).…”

Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Controlled Trial

“…Developmental impairments increase with decreasing gestational age (GA) at birth. 1 Impaired self-regulation, attention and behavioral state, and poor postural control and quality of movements are early signs of developmental concerns. 2,3 Postural control is a prerequisite for the development of optimal movement strategies, and reduced postural control in infants born preterm is related to reduced balance at 6 years.…”

Proactive Care at the Edge of Viability: Making the Gray Zone Less Gray?

“…5 Acknowledging that for some patients the burdens of intensive care (deaths in the NICU but especially long-term morbidity among survivors) may outweigh benefits, they present data to support a proactive approach beginning in utero, aiming to optimize a "trial of life" for infants born at the edge of viability. The EXPRESS investigators recently reported rates of death and NDI at 2.5 years in a cohort of live fetuses at 22 to 26 weeks' gestation.…”