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Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a

Mark Adams1,2, Thomas M Berger3, Cristina Borradori-Tolsa4

  • 1Department of Neonatology, Universitätsspital Zürich, Zürich, Switzerland.

BMJ Open
|March 18, 2019
PubMed

Insights

Higher perinatal activity in Swiss centers is linked to lower mortality for premature infants. Survivors showed comparable outcomes, suggesting benefits of specialized care for extremely preterm babies.

Area of Science:

  • Neonatal Medicine
  • Perinatal Health
  • Developmental Pediatrics

Background:

  • Premature infants born before 28 weeks gestation face significant mortality and morbidity risks.
  • The impact of specialized perinatal center activity on outcomes for extremely preterm infants requires further investigation.

Purpose of the Study:

  • To determine if center-specific perinatal intervention levels correlate with neonatal and neurodevelopmental outcomes at 2 years corrected age.
  • To analyze these associations in two distinct cohorts: infants born at 22-25 weeks and those born at 26-27 weeks gestation.

Main Methods:

  • Retrospective cohort study of live-born infants in Switzerland (2006-2013) born before 28 weeks gestation, excluding major congenital malformations.
  • Analysis of outcomes at 2 years corrected age, including mortality, major neonatal morbidity, and severe-to-moderate neurodevelopmental impairment (NDI).
  • Comparison of outcomes between infants born in high versus low perinatal activity centers.

Main Results:

  • In cohort A (22-25 weeks), high perinatal activity was associated with significantly lower mortality (aOR 0.22).
  • No significant association was found between high perinatal activity and survival with major morbidity or NDI in cohort A.
  • Cohort B (26-27 weeks) results mirrored those of cohort A, indicating consistent benefits across extremely preterm groups.

Conclusions:

  • Swiss centers with high perinatal activity demonstrate a lower risk of mortality for extremely preterm infants.
  • Outcomes for survivors were comparable regardless of center activity level, highlighting the importance of specialized care.
  • The study supports the benefit of higher perinatal activity for infants up to 28 weeks gestation and suggests further research into the burden of care for non-survivors.
Abstract

Keywords:
fetal medicineneonatologyquality in health care

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