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

Abstract

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.

The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6‐Year‐Old Survivors of Periviable Births

“…The higher LVM in adults could be attributed to higher blood pressures in adults who were born preterm than in those born at term,4 whereas blood pressure differences in our cohort were small or nonexistent. Infants,19 children,7 and adolescents8 born preterm have—as in our cohort—been found to exhibit similar or even lower LVM than peers born at term, also in the presence of elevated blood pressure 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20…”

“…Inclusion and exclusion criteria, perinatal characteristics, and data on survival, neonatal morbidity, neurodevelopmental outcomes at 30 months and 6.5 years of age, and vascular outcomes in childhood have been reported previously 9, 10, 11, 12, 13…”

Randomized controlled trials are needed to close the evidence gap in the prevention of preterm birth

“…Apart from the negative health implications of prematurity, the monetary cost is very alarming, with America alone spending over $26.2 billion on medical and educational interventions in addition to the cost of productivity loss (3). Despite global and local achievements in the survival rate of premature infants, the rate of prematurity keeps rising (4).…”

Women Are Designed to Deliver Vaginally and Not by Cesarean Section: An Obstetrician's View

“…The unfavorable effect in late preterm infants is thought to be related to inadequate respiratory adaptation [13]. One-year outcome data from the Swedish express study for deliveries between 22 and 27 weeks did not show an independent favorable effect of CDs [14]. …”