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Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity.

https://arctichealth.org/en/permalink/ahliterature58235
Source
Acta Paediatr. 2004 Aug;93(8):1090-7
Publication Type
Article
Date
Aug-2004
Author
F. Serenius
U. Ewald
A. Farooqi
P A Holmgren
S. Håkansson
G. Sedin
Author Affiliation
Department of Paediatrics, Umeå University, Umeå, Sweden. fredrik.serenius.us@vll.se
Source
Acta Paediatr. 2004 Aug;93(8):1090-7
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Female
Humans
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intensive Care, Neonatal
Logistic Models
Male
Morbidity
Perinatal care
Pregnancy
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden - epidemiology
Abstract
AIM: To determine major neonatal morbidity in surviving infants born at 23-25 weeks, and to identify maternal and infant factors associated with major morbidity. METHODS: The medical records of 224 infants who were delivered at two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Of the 213 liveborn infants, 140 (66%) survived to discharge. Data were analysed by gestational age and considered in three time periods. Logistic regression models were used to identify factors associated with morbidity. RESULTS: Of the survivors, 6% had intraventricular haemorrhage grade > or = 3 (severe IVH) or periventricular leukomalacia (PVL), 15% retinopathy of prematurity > or = stage 3 (severe ROP) and 36% bronchopulmonary dysplasia (BPD). On logistic regression analysis, severe IVH or PVL was associated with duration of mechanical ventilation (odds ratio, OR: 1.53 per 1-wk increment in duration; 95% confidence interval, CI: 1.01-2.33). Severe ROP was associated with the presence of a patent ductus arteriosus (PDA) (OR: 3.31; 95% CI: 1.11-9.90) and birth in time period 3 versus time periods 1 and 2 combined (OR: 6.28; 95% CI: 2.10-18.74). BPD was associated with duration of mechanical ventilation (OR: 2.71 per 1-wk increment in duration; 95% CI: 1.76-4.18) and with the presence of any obstetric complication (OR: 2.67; 95% CI: 1.07-6.65). Gestational age and birthweight were not associated with major morbidity. Of all survivors, 81% were discharged home without severe IVH, PVL or severe ROP. CONCLUSIONS: Increased survival as a result of active perinatal and neonatal management was associated with favourable morbidity rates compared with those in recent studies. Among survivors born at 23-25 weeks, neither gestational age nor birthweight was a significant determinant of major morbidity.
Notes
Comment In: Acta Paediatr. 2004 Aug;93(8):1027-815456188
PubMed ID
15456201 View in PubMed
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Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors.

https://arctichealth.org/en/permalink/ahliterature58251
Source
Acta Paediatr. 2004 Jul;93(7):945-53
Publication Type
Article
Date
Jul-2004
Author
F. Serenius
U. Ewald
A. Farooqi
P A Holmgren
S. Hakansson
G. Sedin
Author Affiliation
Department of Paediatrics, Urmea University, Umeå, Sweden.
Source
Acta Paediatr. 2004 Jul;93(7):945-53
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adult
Delivery, obstetric - statistics & numerical data
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Logistic Models
Maternal Age
Multivariate Analysis
Parity
Pregnancy
Pregnancy outcome
Pregnancy Trimester, Second
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden
Time Factors
Abstract
AIMS: To provide descriptive data on women who delivered at 23-25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. METHODS: Medical records of all women who had delivered in two tertiary care centres in 1992-1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. RESULTS: Of 197 women who delivered at 23-25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by pre-eclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59-3.74), administration of any antenatal steroids (OR: 2.21; 95% Cl: 1.14-4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5-5.73) were associated with survival. CONCLUSIONS: Women who deliver at 23-25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths.
Notes
Comment In: Acta Paediatr. 2004 Aug;93(8):1027-815456188
PubMed ID
15303811 View in PubMed
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Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 2: infant survival.

https://arctichealth.org/en/permalink/ahliterature51952
Source
Acta Paediatr. 2004 Aug;93(8):1081-9
Publication Type
Article
Date
Aug-2004
Author
F. Serenius
U. Ewald
A. Farooqi
P A Holmgren
S. Håkansson
G. Sedin
Author Affiliation
Department of Paediatrics, Umeå University, Umeå, Sweden.
Source
Acta Paediatr. 2004 Aug;93(8):1081-9
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Apgar score
Birth weight
Female
Humans
Infant mortality
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intensive Care, Neonatal
Logistic Models
Multivariate Analysis
Perinatal care
Pregnancy
Pregnancy outcome
Research Support, Non-U.S. Gov't
Retrospective Studies
Survival Rate
Sweden - epidemiology
Abstract
AIM: To determine neonatal survival rates based on both foetal (stillborn) and neonatal deaths among infants delivered at 23-25 wk, and to identify maternal and neonatal factors associated with survival. METHODS: The medical records of 224 infants who were delivered in two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Data were analysed by gestational age groups and considered in three time periods. Logistic regression models were used to identify factors associated with survival. RESULTS: The rate of foetal death was 5%. Of infants born alive, 63% survived to discharge. Survival rates including foetal deaths in the denominator at 23, 24 and 25 wk were 37%, 61% and 74%, respectively, and survival rates excluding foetal deaths were 43%, 63% and 77%, respectively. Of infants born with 1-min Apgar scores of 0-1, 43% survived. In the total cohort, survival rates including foetal deaths in the denominator increased from 52% in time period 1 to 61% in time period 2 and 74% in time period 3 (p
Notes
Comment In: Acta Paediatr. 2004 Aug;93(8):1027-815456188
PubMed ID
15456200 View in PubMed
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Two-thirds of adolescents who received active perinatal care after extremely preterm birth had mild or no disabilities.

https://arctichealth.org/en/permalink/ahliterature281374
Source
Acta Paediatr. 2016 Nov;105(11):1288-1297
Publication Type
Article
Date
Nov-2016
Author
A. Holsti
M. Adamsson
F. Serenius
B. Hägglöf
A. Farooqi
Source
Acta Paediatr. 2016 Nov;105(11):1288-1297
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Case-Control Studies
Child
Child Development
Cognition Disorders - diagnosis - epidemiology
Developmental Disabilities - epidemiology
Female
Gestational Age
Humans
Infant, Extremely Premature
Infant, Newborn
Logistic Models
Male
Perinatal Care - methods - standards
Severity of Illness Index
Social Class
Survival Analysis
Sweden - epidemiology
Time
Wechsler Scales
Abstract
Active perinatal care (APC) increases the survival of extremely preterm (EPT) infants, but may increase the rate of disabilities. We examined neurodevelopmental outcomes in adolescents aged 10-15 years who were born EPT and received APC in two Swedish tertiary care centres.
Cognitive function was assessed using the Wechsler Intelligence Scale for Children, and neurosensory impairments were assessed by reviewing the case records and a standard parent health questionnaire. The outcomes were compared to term-born controls.
We assessed 132 EPT adolescents and 103 controls. The rates of cerebral palsy, moderate to severe visual impairment and moderate to severe hearing impairment were 9%, 4% and 6%, respectively, for the EPT children and zero for the controls. Serious cognitive impairment was present in 31% of the EPT adolescents and 5% of the controls. Combining impairments across domains showed that 34% of EPT adolescents had moderate and severe disabilities compared with 5% of the controls. Impairments were more common at 23-24 weeks of gestational age (43%) than at 25 weeks (28.4%).
Two-thirds (66%) of adolescents born EPT who received APC had mild or no disabilities. Our results are relevant for healthcare providers and clinicians counselling families.
PubMed ID
27275954 View in PubMed
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