Document Detail

Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies.
MedLine Citation:
PMID:  15231908     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: There is a need for evidence-based knowledge regarding perinatal management in extreme prematurity. The benefit of a proactive attitude versus a more selective one is controversial. The objective of the present study was to analyze perinatal practices and infant outcome in extreme prematurity in relation to different management policies in the North (proactive) and South of Sweden. METHODS: A population-based, retrospective, cohort study design was used. Data in the Swedish Medical Birth Register (MBR) from 1985 to 1999 were analyzed according to region of birth and gestational age (22 weeks + 0 days to 27 weeks + 6 days). A total of 3 602 live-born infants were included (North = 1040, South = 2562). Survival was defined as being alive at 1 year. Morbidity in survivors, based on discharge diagnoses of major morbidity during the first year of life, was described by linking the MBR to the Hospital Discharge Register. RESULTS: In infants with a gestational age of 22 to 25 weeks, the proactive policy was significantly associated with 1) increased incidence of live births, 2) higher degree of centralized management, 3) higher frequency of caesarean section, 4) fewer infants with low Apgar score (<4) at 1 and 5 minutes, 5) fewer infants dead within 24 hours, and 6) increased number of infants alive at 1 year. There were no indications of increased morbidity in survivors of the proactive management during the first year of life, and the proportion of survivors without denoted morbidity was larger. CONCLUSION: In infants with a gestational age of 22 to 25 weeks, a proactive perinatal strategy increases the number of live births and improves the infant's postnatal condition and survival without evidence of increasing morbidity in survivors up to 1 year of age.
Stellan Håkansson; Aijaz Farooqi; Per Ake Holmgren; Fredrik Serenius; Ulf Högberg
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatrics     Volume:  114     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-02     Completed Date:  2004-09-30     Revised Date:  2010-10-04    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  58-64     Citation Subset:  AIM; IM    
Department of Pediatrics, Institution of Clinical Science, University Hospital, Umeå, Sweden.
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MeSH Terms
Birth Rate
Birth Weight
Cesarean Section / statistics & numerical data,  trends
Cohort Studies
Gestational Age
Infant Mortality / trends
Infant, Newborn
Infant, Premature*
Infant, Premature, Diseases / epidemiology*
Obstetric Labor, Premature / therapy
Obstetrics / methods
Perinatology / methods*
Pregnancy Outcome / epidemiology*
Retrospective Studies
Survival Rate
Sweden / epidemiology
Comment In:
Pediatrics. 2004 Jul;114(1):264   [PMID:  15231942 ]

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