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Association between Year of Birth and 1-Year Survival among Extremely Preterm Infants in Sweden during 2004-2007 and 2014-2016

Norman, Mikael; Hallberg, Boubou; Abrahamsson, Thomas; Björklund, Lars J. LU ; Domellöf, Magnus; Farooqi, Aijaz; Foyn Bruun, Cathrine; Gadsbøll, Christian; Hellström-Westas, Lena LU and Ingemansson, Fredrik, et al. (2019) In JAMA - Journal of the American Medical Association 321(12). p.1188-1199
Abstract

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... (More)

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.

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JAMA - Journal of the American Medical Association
volume
321
issue
12
pages
12 pages
publisher
American Medical Association
external identifiers
  • scopus:85063324499
ISSN
0098-7484
DOI
10.1001/jama.2019.2021
language
English
LU publication?
yes
id
143f9d59-0d1e-4df2-aa6e-1514b1b98f1a
date added to LUP
2019-04-02 07:57:32
date last changed
2019-05-21 04:20:11
@article{143f9d59-0d1e-4df2-aa6e-1514b1b98f1a,
  abstract     = {<p>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.</p>},
  author       = {Norman, Mikael and Hallberg, Boubou and Abrahamsson, Thomas and Björklund, Lars J. and Domellöf, Magnus and Farooqi, Aijaz and Foyn Bruun, Cathrine and Gadsbøll, Christian and Hellström-Westas, Lena and Ingemansson, Fredrik and Källén, Karin and Ley, David and Maršál, Karel and Normann, Erik and Serenius, Fredrik and Stephansson, Olof and Stigson, Lennart and Um-Bergström, Petra and Håkansson, Stellan},
  issn         = {0098-7484},
  language     = {eng},
  number       = {12},
  pages        = {1188--1199},
  publisher    = {American Medical Association},
  series       = {JAMA - Journal of the American Medical Association},
  title        = {Association between Year of Birth and 1-Year Survival among Extremely Preterm Infants in Sweden during 2004-2007 and 2014-2016},
  url          = {http://dx.doi.org/10.1001/jama.2019.2021},
  volume       = {321},
  year         = {2019},
}