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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 58-64

Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies

Stellan Håkansson, MD, PhD*, Aijaz Farooqi, MD*, Per Åke Holmgren, MD, PhD{ddagger}, Fredrik Serenius, MD, PhD* and Ulf Högberg, MD, PhD{ddagger}

* Department of Pediatrics, Institution of Clinical Science, University Hospital, Umeå, Sweden
{ddagger} Department of Obstetrics & Gynecology, Institution of Clinical Science, University Hospital, Umeå, Sweden

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.

Key Words: perinatal • prematurity • infant • outcome • management

Abbreviations: 25WG, 25-week guideline • GA, gestational age • MBR, Medical Birth Register • CLD, chronic lung disease • IVH, intraventricular hemorrhage • ROP, retinopathy of prematurity • OR, odds ratio • CI, confidence interval

Received for publication Jul 28, 2003; Accepted Nov 24, 2003.




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