Survival rates of extremely preterm infants (gestational age &lt;26 weeks) in Switzerland: impact of the Swiss guidelines for the care of infants born at the limit of viability

Fischer, Nadja; Steurer, Martina A.; Adams, Mark; Berger, Thomas M.

doi:10.1136/adc.2008.154567

Cited by 62 publications

(62 citation statements)

References 39 publications

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“…5,7,10,11,14,[16][17][18]20,36,37,47 Other studies include only infants admitted to the NICU, with survival rates ranging from 0% to 66%. 4,9,[11][12][13][14][15]17,18,20,21,23,24,34 Previous Canadian studies that did not include stillbirth noted survival rates in infants admitted to the NICU of 35.2% to 41.7%. 4,15,24 The survival rate was lower in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these studies, however, have excluded infants that were stillborn or that died before admission to NICU. 3,4,15,[21][22][23][24]27,34 In addition, some studies present data based on birth weight and not gestational age. 29,[40][41][42][43][44] Finally, a number of studies present data from populations that may differ from the Canadian population with respect to ethnicity and access to health care.…”

Section: Introductionmentioning

confidence: 99%

“…29,[40][41][42][43][44] Finally, a number of studies present data from populations that may differ from the Canadian population with respect to ethnicity and access to health care. 3,[7][8][9][10][11][12][13][14][16][17][18][19][20][21][22][23]34,45 Few studies have evaluated maternal outcomes of women delivering at a periviable gestation.…”

Section: Introductionmentioning

confidence: 99%

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Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation .Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation . Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage . Maternal outcomes included Caesarean section, placental abruption, and serious complication . Perinatal outcomes were mortality and serious morbidity .Results: A total of 248 women and 287 infants were included in the study . The rate of Caesarean section was 10 .5% (26/248) and 40 .3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38 .6%), followed by blood transfusion (4 .5% (25/25) . Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded . In each of these, perinatal outcomes similar to the overall group were found . Conclusion:Pregnant women delivering at 23 weeks' gestation are at risk of morbidity . Their infants have high rates of serious morbidity and mortality . Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity .

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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“…6,7,10,11,[14][15][16][17] Håkansson et al 6 found higher survival for infants born at 22 to 25 weeks in health care regions with proactive care than for infants in regions with a restrictive attitude. The Models of Organizing Access to Intensive Care for Very Preterm Babies in Europe (MOSAIC) study 11 calculated a composite obstetric score on the basis of antenatal corticosteroids, antenatal transfer, and cesarean delivery: this composite score varied between European regions and a higher score was associated with lower stillbirth rate and in-hospital mortality of liveborn infants delivered at 24 to 25 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] However, large variability in the intensity of perinatal care and outcome of EPT infants is reported between centers, regions, and countries providing comparative levels of care. 6,[8][9][10][11][12][13][14] Proactive care, conceptualized as a policy of providing a high intensity of care for all EPT births, including those occurring at the edge of viability, 6,15 may decrease the rate of stillbirth [15][16][17] and increase survival of infants born alive. 6,[12][13][14] Even so, there are concerns that active life support for vulnerable infants may increase the proportion of disabled survivors.…”

Section: What This Study Addsmentioning

confidence: 99%

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

et al. 2015

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, 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.

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