Preterm birth in the Nordic countries—Capacity, management and outcome in neonatal care

Abstract

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.

Maternal and neonatal health outcomes for First Nations Australian women and children: A retrospective cohort study in a Western Sydney metropolitan tertiary referral centre

“…Referral centre for high‐risk births and its socioeconomically disadvantaged local population, it was not unexpected to find SCN/NICU admission rates overall in this study to be higher than national rates of SCN/NICU admission (20% vs. 17%) and indeed much higher than rates in Nordic countries (11%) 1,18 …”

“…Referral centre for high-risk births and its socioeconomically disadvantaged local population, it was not unexpected to find SCN/NICU admission rates overall in this study to be higher than national rates of SCN/NICU admission (20% vs. 17%) and indeed much higher than rates in Nordic countries (11%). 1,18 This study reveals a very high rate of smoking in pregnancy in all women, especially amongst First Nations women, and significantly higher rates of drug and alcohol use in First Nations mothers. Of concern, 45.6% of study First Nations women smoked during pregnancy compared with 19.4% of non-First Nations women.…”

Births in the Nordics 2021 to 2022—Pandemic fluctuation or fundamental shift?

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The effects of the COVID-19 pandemic on general and particularly birth preterm rates have been repeatedly analysed. [1][2][3] At the recent Nordic Neonatal Meeting in Oslo, November 2023, we engaged in discussions concerning the total number of births in Denmark and Sweden.

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How do we discharge preterm infants safely without unnecessary delay?

“…These NICUs are all parts of fully financed public healthcare systems providing treatment not restricted by socio‐economic background or type of health insurance. Access and adherence to ante‐ and postnatal healthcare programmes for mothers and infants are free of charge and almost universal, population‐based outcomes after preterm birth are good 4 and infant mortality rates are very low. Parents also have the right to financial support post‐partum facilitating parental presence and family‐centred care in the NICU.…”

“…In 2016 the Norwegian neonatal health atlas documented a more than two‐fold geographic variation in neonatal intensive care unit (NICU) admission rates for near‐term and term infants as well as for antibiotic and ventilator treatment 2,3 . Recently Norman et al 4 . found significant regional differences in care and management of very preterm infants in the Nordic countries.…”