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Centralisation of extremely preterm births and decreased early postnatal mortality in Sweden, 2004-2007 versus 2014-2016

Gadsbøll, Christian LU ; Björklund, Lars J. LU ; Norman, Mikael ; Abrahamsson, Thomas ; Domellöf, Magnus ; Elfvin, Anders ; Farooqi, Aijaz ; Hellström-Westas, Lena LU ; Håkansson, Stellan and Källén, Karin LU , et al. (2025) In Acta Paediatrica, International Journal of Paediatrics 114(2). p.319-331
Abstract

Aim: We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity. Methods: Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004–2007 and 2014–2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes. Results: Among 1626 liveborn infants, 703 were born in 2004–2007 and 923 in 2014–2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval... (More)

Aim: We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity. Methods: Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004–2007 and 2014–2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes. Results: Among 1626 liveborn infants, 703 were born in 2004–2007 and 923 in 2014–2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31–3.07, p = 0.001). The higher 1-year mortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3–4 than inborn infants (22% vs. 14% in 2004–2007, and 22% vs. 13% in 2014–2016, both p < 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%–40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88). Conclusion: Centralisation of EPT births contributed to a lower 1-year mortality in 2014–2016 than that in 2004–2007, attributed to a decrease in deaths before 24 h among inborn infants.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
centralisation of births, extremely preterm, infant mortality, intraventricular haemorrhage, outborn
in
Acta Paediatrica, International Journal of Paediatrics
volume
114
issue
2
pages
319 - 331
publisher
Wiley-Blackwell
external identifiers
  • pmid:39313908
  • scopus:85204673984
ISSN
0803-5253
DOI
10.1111/apa.17429
language
English
LU publication?
yes
id
97e21f23-50ce-4734-a8ca-f67ce1d372f7
date added to LUP
2024-12-02 14:26:12
date last changed
2025-07-15 08:31:43
@article{97e21f23-50ce-4734-a8ca-f67ce1d372f7,
  abstract     = {{<p>Aim: We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity. Methods: Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004–2007 and 2014–2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes. Results: Among 1626 liveborn infants, 703 were born in 2004–2007 and 923 in 2014–2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31–3.07, p = 0.001). The higher 1-year mortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3–4 than inborn infants (22% vs. 14% in 2004–2007, and 22% vs. 13% in 2014–2016, both p &lt; 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%–40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88). Conclusion: Centralisation of EPT births contributed to a lower 1-year mortality in 2014–2016 than that in 2004–2007, attributed to a decrease in deaths before 24 h among inborn infants.</p>}},
  author       = {{Gadsbøll, Christian and Björklund, Lars J. and Norman, Mikael and Abrahamsson, Thomas and Domellöf, Magnus and Elfvin, Anders and Farooqi, Aijaz and Hellström-Westas, Lena and Håkansson, Stellan and Källén, Karin and Normann, Erik and Serenius, Fredrik and Sävman, Karin and Um-Bergström, Petra and Ådén, Ulrika and Ley, David}},
  issn         = {{0803-5253}},
  keywords     = {{centralisation of births; extremely preterm; infant mortality; intraventricular haemorrhage; outborn}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{319--331}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Paediatrica, International Journal of Paediatrics}},
  title        = {{Centralisation of extremely preterm births and decreased early postnatal mortality in Sweden, 2004-2007 versus 2014-2016}},
  url          = {{http://dx.doi.org/10.1111/apa.17429}},
  doi          = {{10.1111/apa.17429}},
  volume       = {{114}},
  year         = {{2025}},
}