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Serenius, F.
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Publications (10 of 32) Show all publications
Hafstrom, M., Kallen, K., Serenius, F., Marsal, K., Rehn, E., Drake, H., . . . Stromberg, B. (2018). Cerebral Palsy in Extremely Preterm Infants. Pediatrics, 141(1), Article ID e20171433.
Open this publication in new window or tab >>Cerebral Palsy in Extremely Preterm Infants
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2018 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 141, no 1, article id e20171433Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND OBJECTIVES: The risk of cerebral palsy (CP) is high in preterm infants and is often accompanied by additional neurodevelopmental comorbidities. The present study describes lifetime prevalence of CP in a population-based prospective cohort of children born extremely preterm, including the type and severity of CP and other comorbidities (ie, developmental delay and/or cognitive impairment, neurobehavioral morbidity, epilepsy, vision and hearing impairments), and overall severity of disability. In this study, we also evaluate whether age at assessment, overall severity of disability, and available sources of information influence outcome results.

METHODS: All Swedish children born before 27 weeks’ gestation from 2004 to 2007 were included (the Extremely Preterm Infants in Sweden Study). The combination of neonatal information, information from clinical examinations and neuropsychological assessments at 2.5 and 6.5 years of age, original medical chart reviews, and extended chart reviews was used.

RESULTS: The outcome was identified in 467 (94.5%) of eligible children alive at 1 year of age. Forty-nine (10.5%) children had a lifetime diagnosis of CP, and 37 (76%) were ambulatory. Fourteen (29%) had CP diagnosed after 2.5 years of age, 37 (76%) had at least 1 additional comorbidity, and 27 (55%) had severe disability. The probability for an incomplete evaluation was higher in children with CP compared with children without CP.

CONCLUSIONS: Children born extremely preterm with CP have various comorbidities and often overall severe disability. The importance of long-term follow-up and of obtaining comprehensive outcome information from several sources in children with disabilities is shown.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-144097 (URN)10.1542/peds.2017-1433 (DOI)000419003300017 ()
Funder
Marianne and Marcus Wallenberg Foundation, 2011.0085Swedish Research Council, 2006-3858Swedish Research Council, 2009-4250Swedish Research Council, 523-2011-3981
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-06-09Bibliographically approved
Bolk, J., Farooqi, A., Hafstrom, M., Aden, U. & Serenius, F. (2018). Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm. JAMA pediatrics, 172(8), 765-774
Open this publication in new window or tab >>Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm
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2018 (English)In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 172, no 8, p. 765-774Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE There are concerns that apparently healthy extremely preterm children face a risk of developing motor impairments, such as developmental coordination disorder. OBJECTIVE To evaluate the prevalence of developmental coordination disorder and associated comorbidities in a national cohort of apparently healthy children born at 22 to 26 gestational weeks, compared alongside term-born peers. DESIGN, SETTING, AND PARTICIPANTS This prospective, population-based cohort study included all children who were consecutively born at 22 to 26 gestational weeks in Sweden from April 1, 2004, through March 31, 2007. At 6.5 years, 441 preterm children were evaluated alongside 371 controls. A total of 275 preterm children (62.4%) and 359 term-born children (96.8%) did not have neurodevelopmental disabilities. Motor assessments were completed for 229 of 275 preterm children (83.3%) and 344 of 359 (95.8%) term-born children, who composed the final study sample. MAIN OUTCOMES AND MEASURES Developmental coordination disorder was defined as a score of the fifth percentile or lower on the Movement Assessment Battery for Children-Second Edition scale, using control group scores. Assessment tools included the Wechsler Intelligence Scale for Children-Fourth Edition, the Brown Attention-Deficit Disorder Scales, the Five to Fifteen questionnaire, and the Strengths and Difficulties questionnaire. RESULTS Of the 229 extremely preterm children and 344 term-born controls who underwent motor assessments, 115 (50.2%) and 194 (56.4%) were boys, respectively. Developmental coordination disorder was present in 85 of 229 (37.1%) preterm children and in 19 of 344 controls (5.5%) (adjusted odds ratio [OR], 7.92; 99% CI, 3.69-17.20). When preterm children with developmental coordination disorder were compared with term-born peers, the risk was increased for total behavioral problems, internalizing, externalizing, attentional problems, hyperactivity, perceptual problems, executive dysfunction, and poor social skills, with adjusted ORs varying from 2.66 (99% CI, 1.09-6.48) for time concepts to 9.06 (99% CI, 3.60-22.8) for attentional problems (all P < .01). When preterm children with and without developmental coordination disorder were compared, preterm children with developmental coordination disorder had more behavioral problems; the adjusted OR for total behavioral problems was 2.71 (99% CI, 1.15-6.37); for externalizing problems, 2.80 (99% CI, 1.10-7.12); for inattention, 3.38 (99% CI, 1.39-8.18); and for combined attention/hyperactivity problems, 3.68 (99% CI, 1.47-9.16) (all P < .01). Parents underestimated the children's motor problems and only a few of the children had received psychological care or physiotherapy. CONCLUSIONS AND RELEVANCE Children who were born extremely preterm faced a high risk for developmental coordination disorder with associated comorbidities. Our findings support the importance of a structured follow-up of motor function, behavior, and cognition. 

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2018
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-151061 (URN)10.1001/jamapediatrics.2018.1394 (DOI)000440869400014 ()29868837 (PubMedID)2-s2.0-85051379768 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-09-05Bibliographically approved
Holsti, A., Serenius, F. & Farooqi, A. (2018). Impact of major neonatal morbidities on adolescents born at 23-25 weeks of gestation. Acta Paediatrica, 107(11), 1893-1901
Open this publication in new window or tab >>Impact of major neonatal morbidities on adolescents born at 23-25 weeks of gestation
2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 11, p. 1893-1901Article in journal (Refereed) Published
Abstract [en]

Aim: More infants born extremely preterm (EPT) are surviving, but major neonatal morbidities are consistently high. This study examined the impact of bronchopulmonary dysplasia (BPD), brain injuries and severe retinopathy of prematurity (ROP) on adolescents who were born EPT.

Methods: We focused on EPT infants born at 23-25 weeks at the Swedish university hospitals in Uppsala and Umea from January 1992 to December 1998. The poor outcome data covered 140 of 142 who survived to 36 weeks, and the chronic conditions data reported by parents covered 132 of 134 still alive at 10-15 years.

Results: Of the 140 survivors at 36 weeks, 29 (21%) had poor outcomes: eight of 140 (6%) died, and 21 of 132 (16%) adolescent survivors had severe neurodevelopmental disabilities (NDD). BPD, severe ROP and/or brain injuries correlated independently with poor outcome. Of those adolescents who were free from BPD, brain injury and severe ROP, 6% had a severe NDD. The corresponding rates with any one, any two or all three neonatal morbidities were 21, 33 and 67%, respectively. BPD and brain injuries were associated with high rates of chronic conditions at 10-15 years of age resulting in functional limitations.

Conclusion: In adolescent EPT survivors, BPD and brain injuries were associated with high rates of chronic conditions and special healthcare needs.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Chronic conditions, Extremely preterm infants, Long-term outcome, Neonatal morbidities, Neurodevelopmental outcome
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-152972 (URN)10.1111/apa.14445 (DOI)000446822800011 ()29893052 (PubMedID)
Funder
Västerbotten County Council, ALF-VLL 67971Sven Jerring Foundation
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2018-11-01Bibliographically approved
Bolk, J., Kaul, Y. F., Hellstrom-Westas, L., Stjernqvist, K., Padilla, N., Serenius, F., . . . Aden, U. (2018). National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years. Acta Paediatrica, 107(5), 831-837
Open this publication in new window or tab >>National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 831-837Article in journal (Refereed) Published
Abstract [en]

Aim: This study aimed to explain the relationship between visual-motor integration (VMI) abilities and extremely preterm (EPT) birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes. Methods: This was part of the population-based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of <27 weeks from April 2004 to March 2007, and 364 term-born controls. At six-and-a-half years of age, we assessed VMI, cognitive function, motor skills and vision. VMI impairment was classified as <-1 standard deviation (SD). Results: The mean (SD) VMI score was 87 (+/- 12) in preterm children compared to 98 (+/- 11) in controls (p < 0.001). VMI impairment was present in 55% of preterm infants and in 78% of children born at 22-23 weeks. Male sex and postnatal steroids showed a weak association with poorer visual-motor performance, whereas low manual dexterity and cognitive function showed a stronger association. Conclusion: Poor VMI performance was common in this EXPRESS cohort of children born EPT. Its strong association to cognition and manual dexterity confirms that all of these factors need to be taken into account when evaluating risks in preterm born children.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
Children, Extremely preterm, Outcome, Perinatal risk factors, Visual-motor integration
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-150709 (URN)10.1111/apa.14231 (DOI)000430115100017 ()29356073 (PubMedID)2-s2.0-85041740422 (Scopus ID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-17Bibliographically approved
Samuelsson, M., Holsti, A., Adamsson, M., Serenius, F., Hägglöf, B. & Farooqi, A. (2017). Behavioral Patterns in Adolescents Born at 23 to 25 Weeks of Gestation. Pediatrics, 140(1), Article ID e20170199.
Open this publication in new window or tab >>Behavioral Patterns in Adolescents Born at 23 to 25 Weeks of Gestation
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2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 140, no 1, article id e20170199Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This study examined mental health outcomes in extremely preterm children (EPT) born at 23 to 25 weeks of gestation between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS; We assessed 132 (98%) of the 134 EPT survivors at 10 to 15 years of age alongside term-born controls. Behavioral and emotional problems were evaluated by using Achenbach's Child Behavior Checklist and Teacher Report Form and Conners' Parent and Teacher scales for attention-deficit/hyperactivity disorder. RESULTS: Parents and teachers reported significantly more problems with internalizing behaviors as well as attention, social, and thought problems in EPT children than in controls, even when those with major neurodevelopmental disabilities (NDDs) were excluded. Multivariate analysis of covariance of the behavioral problems reported by parents and teachers revealed no interactions, hut significant main effects emerged for group status (EPT versus control) and sex, with all effect sizes being medium to large and accounting for 8% to 14% of the variance. Compared with the controls, EPT children without NDDs had significantly increased rates of >= 90th percentile for total Conners' attention-deficit/hyperactivity disorder problem scores (parents: 40% vs 15%, odds ratio: 3.7, P <.001) (teachers: 24% vs 9%, odds ratio: 3.3, P =.005). The corresponding rates were higher in the total population. CONCLUSIONS: EPT children with or without NDDs had behavioral problems characterized by a higher risk for anxiety and attention, social, and thought problems. These findings further strengthen the proposition that a preterm behavioral phenotype is recognizable in adolescents born EPT.

Place, publisher, year, edition, pages
American Academy of Pediatrics, 2017
National Category
Pediatrics Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:umu:diva-138556 (URN)10.1542/peds.2017-0199 (DOI)000404482500033 ()
Available from: 2017-09-14 Created: 2017-09-14 Last updated: 2018-06-09Bibliographically approved
Holsti, A., Adamsson, M., Hägglöf, B., Farooqi, A. & Serenius, F. (2017). Chronic Conditions and Health Care Needs of Adolescents Born at 23 to 25 Weeks' Gestation. Pediatrics, 139(2), Article ID e20162215.
Open this publication in new window or tab >>Chronic Conditions and Health Care Needs of Adolescents Born at 23 to 25 Weeks' Gestation
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2017 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, no 2, article id e20162215Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We examined chronic conditions, functional limitations, and special health care needs in extremely preterm children (EPT; 23-25 weeks' gestation) born between 1992 and 1998 at 2 Swedish tertiary care centers that offered regional and active perinatal care to all live-born EPT infants. METHODS: Of 134 surviving EPT children, 132 (98%) were assessed at 10 to 15 years of age alongside 103 term-born controls. Identification of children with functional limitations and special health care needs was based on a questionnaire administered to parents. Categorization of medical diagnoses and developmental disabilities was based on child examinations, medical record reviews, and parent questionnaires. RESULTS: In logistic regression analyses adjusting for social risk factors and sex, the EPT children had significantly more chronic conditions than the term-born controls, including functional limitations (64% vs 6%; odds ratio [OR], 15; 95% confidence interval [CI], 6.1-37.2; P < .001), compensatory dependency needs (60% vs 29%; OR, 3.8; 95% CI, 2.2-6.6; P < .001), and services above those routinely required by children (64% vs 25%; OR, 5.4; 95% CI, 3.0-9.6; P < .001). Specific diagnoses and disabilities for the EPT group versus controls included cerebral palsy (9.1% vs 0%; P < .001), asthma (21.2% vs 6.8%; P = 001), IQ < -2 SD (31.1% vs 4.9%; P < .001), poor motor skills without neurosensory impairment (21.9% vs 1.9%; P < .001), and psychiatric conditions (15.2% vs 1.9%; P < .001). CONCLUSIONS: Adolescents born EPT have considerable long-term health and educational needs. Few had severe impairments that curtailed major activities of daily life.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-132302 (URN)10.1542/peds.2016-2215 (DOI)000393035100016 ()28108580 (PubMedID)
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2018-06-09Bibliographically approved
Serenius, F., Farooqi, A., Fellman, V., Hafstrom, M., Kallen, K., Lindberg, E., . . . Aden, U. (2016). Developmental problems in extremely preterm children with borderline intellectual functioning and free from neurosensory disabilities at 6.5 years in Sweden (the EXPRESS study). Paper presented at The 6th Congress of the European Academy of Paediatric Societies EAPS, October 21-25, 2016, Geneva, Switzerland. EUROPEAN JOURNAL OF PEDIATRICS, 175(11), 1551-1552
Open this publication in new window or tab >>Developmental problems in extremely preterm children with borderline intellectual functioning and free from neurosensory disabilities at 6.5 years in Sweden (the EXPRESS study)
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2016 (English)In: EUROPEAN JOURNAL OF PEDIATRICS, ISSN 0340-6199, Vol. 175, no 11, p. 1551-1552Article in journal (Refereed) Published
Place, publisher, year, edition, pages
New York: Springer, 2016
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-130468 (URN)10.1007/s00431-016-2785-8 (DOI)000390040700444 ()
Conference
The 6th Congress of the European Academy of Paediatric Societies EAPS, October 21-25, 2016, Geneva, Switzerland
Available from: 2017-01-23 Created: 2017-01-20 Last updated: 2018-06-09Bibliographically approved
Farooqi, A., Adamsson, M., Serenius, F. & Hägglöf, B. (2016). Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation. PLoS ONE, 11(3), Article ID e0151819.
Open this publication in new window or tab >>Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0151819Article in journal (Refereed) Published
Abstract [en]

Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive sub-scales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers' responses on Achenbach's Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P < 0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ > 70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers' ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-119281 (URN)10.1371/journal.pone.0151819 (DOI)000372694700068 ()26999522 (PubMedID)
Available from: 2016-06-02 Created: 2016-04-15 Last updated: 2018-06-07Bibliographically approved
Serenius, F., Ewald, U., Farooqi, A., Fellman, V., Hafstrom, M., Hellgren, K., . . . Kallen, K. (2016). Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden. JAMA pediatrics, 170(10), 954-963
Open this publication in new window or tab >>Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden
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2016 (English)In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 170, no 10, p. 954-963Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Active perinatal care increases the rate of survival of extremely preterm infants, but there are concerns that improved survival might increase the rate of disabled survivors. OBJECTIVE To determine the neurodevelopmental outcomes of a national cohort of children 6.5 years of age who had been born extremely preterm (<27 weeks' gestational age) in Sweden. DESIGN, SETTING, AND PARTICIPANTS Population-based prospective cohort study of consecutively born extremely preterm infants. All of these infants were born in Sweden during the period from April 1, 2004, to March 31, 2007. Of 707 live-born extremely preterm infants, 486 (68.7%) survived to 6.5 years of age. These children were assessed and compared with matched controls who had been born at term. Comparison estimates were adjusted for demographic differences. Assessments ended in February 2014, and analysis started thereafter. MAIN OUTCOMES AND MEASURES Cognitive ability was measured with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV), and the mean (SD) scores of the children who had been born extremely preterm were compared with those of the controls. Clinical examinations and parental questionnaires were used for diagnosis of cerebral palsy, hearing and vision impairments, and cognition for the children who were not assessed with the WISC-IV. RESULTS Of 486 eligible infants who were born extremely preterm, 441 (90.7%) were assessed at 6.5 years of age (59 by medical record review only) alongside 371 controls. The adjusted mean (SD) full-scale WISC-IV score was 14.2 (95% CI, 12.1-16.3) points lower for children who had been born extremely preterm than for controls. Cognitive disability was moderate for 18.8% of extremely preterm children and 2.2% of controls (P < .001), and it was severe for 11.1% of extremely preterm children and 0.3% of controls (P < .001). Cerebral palsy was observed in 9.5% of extremely preterm children and 0.0% of controls (P < .001), blindness was observed in 2.0% of extremely preterm children and 0.0% of controls (P < .001), and hearing impairment was observed in 2.1% of extremely preterm children and 0.5% of controls (P = .07). Overall, 36.1%(95% CI, 31.7%-40.6%) of extremely preterm children had no disability, 30.4%(95% CI 26.3%-34.8%) had mild disability, 20.2%(95% CI, 16.6%-24.2%) had moderate disability, and 13.4%(95% CI, 10.5%-16.9%) had severe disability. For extremely preterm children, moderate or severe overall disability decreased with gestational age at birth (adjusted odds ratio per week, 0.65 [95% CI, 0.54-0.79]; P < .001) and increased from 26.6% to 33.5%(P = .01) for children assessed both at 2.5 and 6.5 years. CONCLUSIONS AND RELEVANCE Of the 441 extremely preterm infants who had received active perinatal care, 293 (66.4%) had no or mild disability at 6.5 years; of the 371 controls, 11 (3.0%) had moderate or severe disability. Disability rates at 6.5 years increased relative to the rates at 2.5 years. Results are relevant for health care professionals and planners, and for clinicians counseling families facing extremely preterm births.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-127615 (URN)10.1001/jamapediatrics.2016.1210 (DOI)000385643000014 ()27479919 (PubMedID)
Available from: 2016-11-30 Created: 2016-11-16 Last updated: 2018-06-09Bibliographically approved
Källén, K., Serenius, F., Westgren, M. & Maršál, K. (2015). Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS). Acta Obstetricia et Gynecologica Scandinavica, 94(11), 1203-1214
Open this publication in new window or tab >>Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS)
2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, p. 1203-1214Article in journal (Refereed) Published
Abstract [en]

Introduction: A population-based observational study investigated the contribution of obstetric factors to the survival and postnatal development of extremely preterm infants. Material and methods: Mortality up to 1 year and neurodevelopment at 2.5 years (Bayley-III test, cerebral palsy, vision, hearing) were evaluated in infants born before 27weeks of gestation in Sweden 2004-2007 (n=1011), using logistic regression analyses of risk factors. Results: Of 844 fetuses alive at admission, 8.4% died in utero before labor, 7.8% died intrapartum. Of 707 live-born infants, 15% died within 24h, 70% survived 365days, 64% were assessed at 2.5years. The risk of death within 24h after birth decreased with gestational age [odds ratio (OR) 0.3; 95% CI 0.2-0.4], antenatal corticosteroids (OR 0.3; 95% CI 0.1-0.6), and cesarean section (OR 0.4; 95% CI 0.2-0.9); it increased with multiple birth (OR 3.0; 95% CI 1.5-6.0), vaginal breech delivery (OR 2.3; 95% CI 1.0-5.1), 5-min Apgar score <4 (OR 50.4; 95% CI 28.2-90.2), and birth at a level II hospital (OR 2.6; 95% CI 1.2-5.3). The risk of death between 1 and 365 days remained significantly decreased for gestational age and corticosteroids. The risk of mental developmental delay at 2.5 years decreased with gestational age, birthweight and fetal growth; it increased with vaginal breech delivery (OR 2.0; 95% CI 1.2-7.4), male gender, low Apgar score and high Clinical Risk Index for Babies score. Conclusion: Several obstetric factors, including abdominal delivery, influenced the risk of death within the first day of life, but not later. Antenatal corticosteroids and gestational age decreased the mortality up to 1 year. Mental developmental delay was related to vaginal breech delivery.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Extremely preterm birth, mortality, risk factors, obstetric interventions, neurodevelopmental tcome, cesarean section, breech delivery
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-111143 (URN)10.1111/aogs.12726 (DOI)000362844400009 ()26249263 (PubMedID)
Available from: 2015-11-12 Created: 2015-11-06 Last updated: 2018-06-07Bibliographically approved
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