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Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
Vise andre og tillknytning
2015 (engelsk)Inngår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 135, nr 5, s. E1163-E1172Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (<27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. RESULTS: Each 5-point increment in GA-specific activity score reduced the stillbirth risk (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) and the 1-year mortality risk (aOR: 0.84; 95% CI: 0.78-0.91) in the primary population and the 1-year mortality risk in live-born infants (aOR: 0.86; 95% CI: 0.79-0.93). In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22- to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA. CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

sted, utgiver, år, opplag, sider
2015. Vol. 135, nr 5, s. E1163-E1172
Emneord [en]
VRIES LS, 1992, BEHAVIOURAL BRAIN RESEARCH3RD MEETING OF THE CHILD VISION RESEARCH SOC :
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-104376DOI: 10.1542/peds.2014-2988ISI: 000353728400007PubMedID: 25896833Scopus ID: 2-s2.0-84929492458OAI: oai:DiVA.org:umu-104376DiVA, id: diva2:838952
Tilgjengelig fra: 2015-07-01 Laget: 2015-06-10 Sist oppdatert: 2023-03-24bibliografisk kontrollert

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