This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (41)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Håkansson, S.
Right arrow Articles by Högberg, U.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Håkansson, S.
Right arrow Articles by Högberg, U.
Related Collections
Right arrow Premature & Newborn
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?
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.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
N Fischer, M A Steurer, M Adams, T M Berger, and for the Swiss Neonatal Network
Survival rates of extremely preterm infants (gestational age <26 weeks) in Switzerland: impact of the Swiss guidelines for the care of infants born at the limit of viability
Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2009; 94(6): F407 - F413.
[Abstract] [Full Text] [PDF]


Home page
Arch OphthalmolHome page
D. Austeng, K. B. M. Kallen, U. W. Ewald, P. G. Jakobsson, and G. E. Holmstrom
Incidence of Retinopathy of Prematurity in Infants Born Before 27 Weeks' Gestation in Sweden
Arch Ophthalmol, October 1, 2009; 127(10): 1315 - 1319.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
R. A. Gargus, B. R. Vohr, J. E. Tyson, P. High, R. D. Higgins, L. A. Wrage, and K. Poole
Unimpaired Outcomes for Extremely Low Birth Weight Infants at 18 to 22 Months
Pediatrics, July 1, 2009; 124(1): 112 - 121.
[Abstract] [Full Text] [PDF]


Home page
JAMAHome page
The EXPRESS Group
One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden
JAMA, June 3, 2009; 301(21): 2225 - 2233.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
J. D. Lantos and W. Meadow
Variation in the Treatment of Infants Born at the Borderline of Viability
Pediatrics, June 1, 2009; 123(6): 1588 - 1590.
[Full Text] [PDF]


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
S Craig, E McCall, A Bell, and R Tubman
Improving survival for infants of <26 weeks' gestation, 1995-2005
Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2009; 94(3): F229 - F230.
[Full Text] [PDF]


Home page
PediatricsHome page
F. Bodeau-Livinec, N. Marlow, P.-Y. Ancel, J. J. Kurinczuk, K. Costeloe, and M. Kaminski
Impact of Intensive Care Practices on Short-Term and Long-term Outcomes for Extremely Preterm Infants: Comparison Between the British Isles and France
Pediatrics, November 1, 2008; 122(5): e1014 - e1021.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
M. H. Malloy
Impact of Cesarean Section on Neonatal Mortality Rates Among Very Preterm Infants in the United States, 2000-2003
Pediatrics, August 1, 2008; 122(2): 285 - 292.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
J. Zeitlin, E. S. Draper, L. Kollee, D. Milligan, K. Boerch, R. Agostino, L. Gortner, P. Van Reempts, J.-L. Chabernaud, J. Gadzinowski, et al.
Differences in Rates and Short-term Outcome of Live Births Before 32 Weeks of Gestation in Europe in 2003: Results From the MOSAIC Cohort
Pediatrics, April 1, 2008; 121(4): e936 - e944.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
E. F. Bell, D. G. Batton, A. R. Stark, and On behalf of the American Academy of Pediatrics Co
Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns: In Reply
Pediatrics, June 1, 2007; 119(6): 1267 - 1269.
[Full Text] [PDF]


Home page
PediatricsHome page
V. Tommiska, K. Heinonen, L. Lehtonen, M. Renlund, T. Saarela, O. Tammela, M. Virtanen, and V. Fellman
No Improvement in Outcome of Nationwide Extremely Low Birth Weight Infant Populations Between 1996-1997 and 1999-2000
Pediatrics, January 1, 2007; 119(1): 29 - 36.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
V. M. Kamoji, J. S. Dorling, B. N. Manktelow, E. S. Draper, and D. J. Field
Extremely Growth-Retarded Infants: Is There a Viability Centile?
Pediatrics, August 1, 2006; 118(2): 758 - 763.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
J. M. Peerzada, J. Schollin, and S. Hakansson
Delivery room decision-making for extremely preterm infants in Sweden.
Pediatrics, June 1, 2006; 117(6): 1988 - 1995.
[Abstract] [Full Text] [PDF]


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
J L Watts and S Saigal
Outcome of extreme prematurity: as information increases so do the dilemmas.
Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2006; 91(3): F221 - F225.
[Abstract] [Full Text] [PDF]


Home page
PediatricsHome page
K. Mikkola, N. Ritari, V. Tommiska, T. Salokorpi, L. Lehtonen, O. Tammela, L. Paakkonen, P. Olsen, M. Korkman, V. Fellman, et al.
Neurodevelopmental Outcome at 5 Years of Age of a National Cohort of Extremely Low Birth Weight Infants Who Were Born in 1996-1997
Pediatrics, December 1, 2005; 116(6): 1391 - 1400.
[Abstract] [Full Text] [PDF]


Home page
NeoReviewsHome page
S. Ho and S. Saigal
Current Survival and Early Outcomes of Infants of Borderline Viability
NeoReviews, March 1, 2005; 6(3): e123 - e132.
[Full Text] [PDF]


Home page
PediatricsHome page
J. M. Lorenz
Proactive Management of Extremely Premature Infants
Pediatrics, July 1, 2004; 114(1): 264 - 264.
[Full Text] [PDF]