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Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS)
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden.
2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, 1203-1214 p.Article 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. Vol. 94, no 11, 1203-1214 p.
Keyword [en]
Extremely preterm birth, mortality, risk factors, obstetric interventions, neurodevelopmental tcome, cesarean section, breech delivery
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:umu:diva-111143DOI: 10.1111/aogs.12726ISI: 000362844400009PubMedID: 26249263OAI: oai:DiVA.org:umu-111143DiVA: diva2:868987
Available from: 2015-11-12 Created: 2015-11-06 Last updated: 2015-11-12Bibliographically approved

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