Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016.

Autor:	Norman M; Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.; Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden., Hallberg B; Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden., Abrahamsson T; Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden., Björklund LJ; Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden., Domellöf M; Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden., Farooqi A; Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden., Foyn Bruun C; Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden., Gadsbøll C; Departments of Clinical and Experimental Medicine and Pediatrics, Linköping University, Linköping, Sweden.; Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden., Hellström-Westas L; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Ingemansson F; Department of Pediatrics, Ryhov County Hospital, Jönköping County Council, Jonkoping, Sweden., Källén K; Centre for Reproductive Epidemiology, Lund University, Lund, Sweden., Ley D; Departments of Clinical Sciences and Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden., Maršál K; Departments of Clinical Sciences and Obstetrics and Gynecology, Lund University, Skåne University Hospital, Lund, Sweden., Normann E; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Serenius F; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Stephansson O; Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden., Stigson L; Department of Pediatrics, Institute for Clinical Sciences, Queen Silvia Children's Hospital, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden., Um-Bergström P; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.; Sachs' Children and Youth Hospital, Department of Neonatal Medicine, Södersjukhuset, Stockholm, Sweden., Håkansson S; Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.; Departments of Clinical Sciences and Pediatrics, Umeå University, Umeå Sweden.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2019 Mar 26; Vol. 321 (12), pp. 1188-1199.
DOI:	10.1001/jama.2019.2021
Abstrakt:	Importance: Since 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown. Objective: To compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016. Design, Setting and Participants: All births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016. Exposures: Delivery at 22-26 weeks' gestational age. Main Outcomes and Measures: The primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia). Results: During 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008). Conclusions and Relevance: Among live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.
Databáze:	MEDLINE
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