EXPRESS study shows significant regional differences in 1‐year outcome of extremely preterm infants in Sweden

Abstract

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.

Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe

“…When infant characteristics were added into the risk adjustment model, the variation in overall stillbirth and in-hospital mortality rates across the study regions reduced by nearly onequarter (23.3%), indicating the lack 7 Investigation of the effect of adjusting for maternal, pregnancy, and infant characteristics by the timing of death shows that interregional variation persists at all 3 specified timings. This is contrary to the findings of the EXPRESS study in Sweden, 11 which concluded that in the most extreme preterm infants, any regional differences were established <12 hours after birth, suggesting they could be related to variations in immediate perinatal practices. The continued wide variation in mortality for infants ≥12 hours of age in the EPICE cohort could indicate that there is variation in the quality, access, and provision of neonatal care across Europe.…”

Early and long-term outcome of infants born extremely preterm

“…Survival at the lowest gestational ages (23–24 weeks) varies in population-based reports, primarily as different countries and hospitals assume contrasting stances as to the provision of active care (figure 1). Data from the USA most vividly demonstrate this variation;1 survival is highest in situations where more active obstetric and neonatal management is practised 2. Interpreting survival without knowing the proportion of live births for whom active stabilisation was given is impossible and reports need to be explicit with regard to this.…”

Long-Term Neurodevelopmental and Functional Outcomes of Infants Born Very Preterm and/or with a Very Low Birth Weight

“…Among the improvements are the widespread application of antenatal glucocorticoid therapy, the introduction of synthetic surfactant, and a tendency towards more aggressive feeding strategies, although regional differences in the treatment of VP and VLBW infants do exist [13]. Therefore, the entities VP and VLBW can only be compared between populations that have received the same care.…”