Document Detail


One-year survival of extremely preterm infants after active perinatal care in Sweden.
MedLine Citation:
PMID:  19491184     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 >2, retinopathy of prematurity stage >2, 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.
Authors:
; Vineta Fellman; Lena Hellström-Westas; Mikael Norman; Magnus Westgren; Karin Källén; Hugo Lagercrantz; Karel Marsál; Fredrik Serenius; Margareta Wennergren
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  301     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-03     Completed Date:  2009-06-08     Revised Date:  2009-06-15    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2225-33     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Lund University Hospital, S-221 85 Lund, Sweden. karel.marsal@med.lu.se.
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MeSH Terms
Descriptor/Qualifier:
Female
Gestational Age
Humans
Infant
Infant Mortality
Infant, Newborn
Infant, Premature*
Infant, Premature, Diseases / mortality*
Intensive Care, Neonatal
Male
Morbidity
Perinatal Care*
Perinatal Mortality
Pregnancy
Premature Birth
Prospective Studies
Risk
Survival Analysis
Sweden / epidemiology
Investigator
Investigator/Affiliation:
Mats Blennow / ; Uwe Ewald / ; Tomas Fritz / ; Per Ake Holmgren / ; Annika Jeppsson / ; Eva Lindberg / ; Anita Lundqvist / ; Solveig Nordén Lindeberg / ; Elisabeth Olhager / ; Ingrid Ostlund / ; Marija Simic / ; Gunnar Sjörs / ; Lennart Stigson / ; Vineta Fellman / ; Lena Hellström-Westas / ; Mikael Norman / ; Magnus Westgren / ; Gerd Holmström / ; Ricardo Laurini / ; Karin Stjernqvist / ; Karin Källén / ; Hugo Lagercrantz / ; Karel Marsál / ; Fredrik Serenius / ; Margareta Wennergren / ; Tore Nilstun / ; Petra Otterblad Olausson / ; Bo Strömberg /
Comments/Corrections
Comment In:
JAMA. 2009 Jun 3;301(21):2270-1   [PMID:  19491191 ]

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