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Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal
Stellan Håkansson1, Aijaz Farooqi, Per Ake Holmgren
1Department of Pediatrics, Institution of Clinical Science, University Hospital, Umeå, Sweden. stellan.hakansson@vll.se
Insights
A proactive perinatal management strategy for extremely premature infants (22-25 weeks gestation) significantly increases live births and survival rates. This approach improves infant outcomes without raising morbidity in survivors up to one year.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Public Health
Background:
- Management policies for extreme prematurity (22-27 weeks gestation) vary, with ongoing debate regarding proactive versus selective approaches.
- Evidence-based knowledge on optimal perinatal management for extremely premature infants is crucial for improving outcomes.
- Regional differences in management strategies exist, necessitating analysis of their impact on infant survival and morbidity.
Purpose of the Study:
- To compare perinatal practices and infant outcomes in extreme prematurity between proactive (North Sweden) and selective (South Sweden) management policies.
- To analyze the association between different management strategies and survival rates in extremely premature infants.
- To evaluate the incidence of major morbidity in survivors of extreme prematurity under different management approaches.
Main Methods:
- Retrospective, population-based cohort study utilizing data from the Swedish Medical Birth Register (1985-1999).
- Inclusion of 3,602 live-born infants with gestational age from 22 weeks + 0 days to 27 weeks + 6 days.
- Analysis of survival at 1 year and major morbidity by linking birth register data with the Hospital Discharge Register.
Main Results:
- In infants born between 22 and 25 weeks gestation, the proactive policy was linked to increased live births and centralized management.
- Proactive management showed a higher frequency of caesarean sections, fewer infants with low Apgar scores, and reduced early mortality (within 24 hours).
- Significantly more infants survived to 1 year under the proactive strategy, with no increase in major morbidity among survivors.
Conclusions:
- A proactive perinatal strategy for infants aged 22-25 weeks gestation demonstrably increases live birth rates.
- This proactive approach improves postnatal condition and enhances survival rates for extremely premature infants.
- The study found no evidence of increased morbidity in survivors up to one year of age with proactive management.
Objective:
There is a need for evidence-based knowledge regarding perinatal management in extreme prematurity. The benefit of a proactive attitude versus a more selective one is controversial. The objective of the present study was to analyze perinatal practices and infant outcome in extreme prematurity in relation to different management policies in the North (proactive) and South of Sweden.
Methods:
A population-based, retrospective, cohort study design was used. Data in the Swedish Medical Birth Register (MBR) from 1985 to 1999 were analyzed according to region of birth and gestational age (22 weeks + 0 days to 27 weeks + 6 days). A total of 3 602 live-born infants were included (North = 1040, South = 2562). Survival was defined as being alive at 1 year. Morbidity in survivors, based on discharge diagnoses of major morbidity during the first year of life, was described by linking the MBR to the Hospital Discharge Register.
Results:
In infants with a gestational age of 22 to 25 weeks, the proactive policy was significantly associated with 1) increased incidence of live births, 2) higher degree of centralized management, 3) higher frequency of caesarean section, 4) fewer infants with low Apgar score (<4) at 1 and 5 minutes, 5) fewer infants dead within 24 hours, and 6) increased number of infants alive at 1 year. There were no indications of increased morbidity in survivors of the proactive management during the first year of life, and the proportion of survivors without denoted morbidity was larger.
Conclusion:
In infants with a gestational age of 22 to 25 weeks, a proactive perinatal strategy increases the number of live births and improves the infant's postnatal condition and survival without evidence of increasing morbidity in survivors up to 1 year of age.
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