One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden

被引：486

作者：

Blennow, Mats ^{[1
,2
]}

Ewald, Uwe ^{[3
]}

Fritz, Tomas ^{[4
]}

Holmgren, Per Ake ^{[5
]}

Jeppsson, Annika ^{[6
]}

Lindberg, Eva ^{[7
]}

Lundqvist, Anita ^{[8
]}

Lindeberg, Solveig Norden ^{[9
]}

Olhager, Elisabeth ^{[10
]}

Ostlund, Ingrid ^{[11
]}

Simic, Marija ^{[12
]}

Sjoers, Gunnar ^{[13
]}

Stigson, Lennart ^{[14
]}

Fellman, Vineta ^{[15
]}

Hellstrom-Westas, Lena ^{[16
]}

Norman, Mikael ^{[2
,17
]}

Westgren, Magnus ^{[18
]}

Holmstrom, Gerd ^{[19
]}

Laurini, Ricardo ^{[20
]}

Stjernqvist, Karin ^{[21
]}

Kallen, Karin ^{[22
]}

Lagercrantz, Hugo ^{[23
,24
]}

Marsal, Karel ^{[25
]}

Serenius, Fredrik ^{[26
]}

Wennergren, Margareta ^{[27
]}

Nilstun, Tore ^{[28
]}

Olausson, Petra Otterblad ^{[29
]}

Stromberg, Bo ^{[13
]}

机构：

[1] Karolinska Univ Hosp, Dept Pediat, Huddinge, Sweden

[2] Karolinska Inst, Dept Clin Invest Intervent & Technol, Stockholm, Sweden

[3] Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden

[4] Sahlgrens Univ Hosp, Dept Obstet & Gynecol, S-41345 Gothenburg, Sweden

[5] Umea Univ, Dept Clin Sci Obstetr & Gynecol, Umea, Sweden

[6] Linkoping Univ, Dept Obstet & Gynecol, Linkoping, Sweden

[7] Univ Orebro, Dept Pediat, Orebro, Sweden

[8] Lund Univ, Dept Hlth Sci, Lund, Sweden

[9] Uppsala Univ, Dept Obstet & Gynecol, Uppsala, Sweden

[10] Linkoping Univ, Dept Pediat, S-58183 Linkoping, Sweden

[11] Orebro Univ Hosp, Dept Obstet & Gynecol, Orebro, Sweden

[12] Karolinska Univ Hosp Solna, Dept Obstet & Gynecol, Stockholm, Sweden

[13] Uppsala Univ, Dept Pediat, Uppsala, Sweden

[14] Sahlgrens Univ Hosp, Dept Pediat, Gothenburg, Sweden

[15] Lund Univ, Dept Pediat, S-22100 Lund, Sweden

[16] Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden

[17] Karolinska Univ Hosp, Dept Pediat, Huddinge, Sweden

[18] Karolinska Univ Hosp Huddinge, Dept Obstet & Gynecol, Stockholm, Sweden

[19] Uppsala Univ, Dept Ophthalmol, Uppsala, Sweden

[20] Nordland Hosp, Dept Pathol, Bodo, Norway

[21] Lund Univ, Dept Psychol, S-22100 Lund, Sweden

[22] Lund Univ, Ctr Reprod Epidemiol, S-22100 Lund, Sweden

[23] Karolinska Inst, Dept Women & Child Hlth, Stockholm, Sweden

[24] Astrid Lindgren Childrens Hosp, Stockholm, Sweden

[25] Lund Univ, Dept Obstet & Gynecol, S-22100 Lund, Sweden

[26] Umea Univ, Dept Clin Sci, S-90187 Umea, Sweden

[27] Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Gothenburg, Sweden

[28] Lund Univ, Dept Med Eth, S-22100 Lund, Sweden

[29] Natl Board Hlth & Welf, Ctr Epidemiol, Stockholm, Sweden

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 301卷 / 21期

基金：

瑞典研究理事会;

关键词：

WEEKS GESTATIONAL-AGE; INTENSIVE-CARE; BIRTH-WEIGHT; POPULATION; MORBIDITY; BORN; MORTALITY; LEVEL; MANAGEMENT; THRESHOLD;

D O I：

10.1001/jama.2009.771

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context Up-to-date information on infant survival after extremely preterm birth is needed for assessing perinatal care services, clinical guidelines, and parental counseling. Objective To determine the 1-year survival in all infants born before 27 gestational weeks in Sweden during 2004-2007. Design, Setting, and Patients Population-based prospective observational study of extremely preterm infants (707 live-born and 304 stillbirths) born to 887 mothers in 904 deliveries (102 multiple births) in all obstetric and neonatal units in Sweden from April 1, 2004, to March 31, 2007. Main Outcome Measures Infant survival to 365 days and survival without major neonatal morbidity (intraventricular hemorrhage grade > 2, retinopathy of prematurity stage > 2, periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia). Associations between perinatal interventions and survival. Results The incidence of extreme prematurity was 3.3 per 1000 infants. Overall perinatal mortality was 45% (from 93% at 22 weeks to 24% at 26 weeks), with 30% stillbirths, including 6.5% intrapartum deaths. Of live-born infants, 91% were admitted to neonatal intensive care and 70% survived to 1 year of age (95% confidence interval [CI], 67%-73%). The Kaplan-Meier survival estimates for 22, 23, 24, 25, and 26 weeks were 9.8% (95% CI, 4%-23%), 53% ( 95% CI, 44%-63%), 67% (95% CI, 59%-75%), 82% (95% CI, 76%-87%), and 85% ( 95% CI, 81%-90%), respectively. Lower risk of infant death was associated with tocolytic treatment (adjusted for gestational age odds ratio [ OR], 0.43; 95% CI, 0.36-0.52), antenatal corticosteroids (OR, 0.44; 95% CI, 0.24-0.81), surfactant treatment within 2 hours after birth ( OR, 0.47; 95% CI, 0.32-0.71), and birth at a level III hospital (OR, 0.49; 95% CI, 0.32-0.75). Among 1-year survivors, 45% had no major neonatal morbidity. Conclusion During 2004 to 2007, 1-year survival of infants born alive at 22 to 26 weeks of gestation in Sweden was 70% and ranged from 9.8% at 22 weeks to 85% at 26 weeks. JAMA. 2009;301(21):2225-2233 www.jama.com

引用

页码：2225 / 2233

页数：9

共 45 条

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