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An International Comparison of Death Classification at 22 to 25 Weeks' Gestational Age.

https://arctichealth.org/en/permalink/ahliterature299751
Source
Pediatrics. 2018 07; 142(1):
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2018
Author
Lucy K Smith
Naho Morisaki
Nils-Halvdan Morken
Mika Gissler
Paromita Deb-Rinker
Jocelyn Rouleau
Stellan Hakansson
Michael R Kramer
Michael S Kramer
Author Affiliation
Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
Source
Pediatrics. 2018 07; 142(1):
Date
07-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Canada
Female
Fetal Death
Finland
Gestational Age
Humans
Infant
Infant mortality
Infant, Newborn
Japan
Norway
Pregnancy
Registries
Survival Rate
Sweden
United Kingdom
United States
Abstract
To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates.
We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11?144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n = 2992), Norway (2010-2014; n = 409), Finland (2010-2015; n = 348), Sweden (2011-2014; n = 489), and Japan (2014-2015; n = 2288) to compare neonatal survival rates using different denominators: all births, births alive at the onset of labor, live births, live births surviving to 1 hour, and live births surviving to 24 hours.
For births at 22 weeks' gestation, neonatal survival rates for which we used live births as the denominator varied from 3.7% to 56.7% among the 7 countries. This variation decreased when the denominator was changed to include stillbirths (ie, all births [1.8%-22.3%] and fetuses alive at the onset of labor [3.7%-38.2%]) or exclude early deaths and limited to births surviving at least 12 hours (50.0%-77.8%). Similar trends were seen for infants born at 23 weeks' gestation. Variation diminished considerably at 24 and 25 weeks' gestation.
International variation in neonatal survival rates at 22 to 23 weeks' gestation diminished considerably when including stillbirths in the denominator, revealing the variation arises in part from differences in the proportion of births reported as live births, which itself is closely connected to the provision of active care.
PubMed ID
29899042 View in PubMed
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