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Observational Study
. 2014 Jan;103(1):27-37.
doi: 10.1111/apa.12421. Epub 2013 Oct 30.

EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden

Fredrik Serenius  1 , Gunnar Sjörs, Mats Blennow, Vineta Fellman, Gerd Holmström, Karel Maršál, Eva Lindberg, Elisabeth Olhager, Lennart Stigson, Magnus Westgren, Karin Källen; EXPRESS study group
Affiliations
Free PMC article
Observational Study

EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden

Fredrik Serenius et al. Acta Paediatr. 2014 Jan.
Free PMC article

Abstract

Aim: The aim of this study was to investigate differences in mortality up to 1 year of age in extremely preterm infants (before 27 weeks) born in seven Swedish healthcare regions.

Methods: National prospective observational study of consecutively born, extremely preterm infants in Sweden 2004-2007. Mortality was compared between regions. Crude and adjusted odds ratios and 95% CI were calculated.

Results: Among 844 foetuses alive at mother's admission for delivery, regional differences were identified in perinatal mortality for the total group (22-26 weeks) and in the stillbirth and perinatal and 365-day mortality rates for the subgroup born at 22-24 weeks. Among 707 infants born alive, regional differences were found both in mortality before 12 h and in the 365-day mortality rate for the subgroup (22-24 weeks) and for the total group (22-26 weeks). The mortality rates were consistently lower in two healthcare regions. There were no differences in the 365-day mortality rate for infants alive at 12 h or for infants born at 25 weeks. Neonatal morbidity rates among survivors were not higher in regions with better survival rates. Perinatal practices varied between regions.

Conclusion: Mortality rates in extremely preterm infants varied considerably between Swedish healthcare regions in the first year after birth, particularly between the most immature infants.

Keywords: Cohort study; Extremely preterm infant; Morbidity; Mortality; Outcome.

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Figures

Figure 1
Figure 1
Map of Sweden and the seven healthcare regions.
Figure 2
Figure 2
Adjusted odds ratios for death among foetuses alive at mother's admission for delivery among the Swedish healthcare regions (reference = Stockholm region), according to the time of death. Odds ratios are adjusted for gestational age (weeks) and (weeks2), multiple births (yes/no), gender and birthweight standard deviation score . Adjusted proportion of variation that can be explained by the regional difference (R2): stillbirth: 22–24 weeks, 0.05; 22–26 weeks, 0.01. Perinatal death: 22–24 weeks, 0.10; 22–26 weeks 0.02. Death before 365 days: 22–24 weeks, 0.06; 22–26 weeks, 0.01.
Figure 3
Figure 3
Adjusted Odds ratios for death among infants born alive and neonatal morbidity among survivors to 365 days between the Swedish healthcare regions (reference = Stockholm region), according to the time of death. Odds ratios are adjusted for gestational age (weeks) and (weeks2), multiple births (yes/no), gender and birthweight standard deviation score . Adjusted proportion of variation that can be explained by the regional difference (R2): death before 12 h: 22–24 weeks, 0.13; 22–26 weeks, 0.05. Death 0–365 days: 22–24 weeks, 0.06; 22–26 weeks 0.02. Neonatal morbidity: 22–24 weeks, 0.06; 22–26 weeks, 0.01. Neonatal morbidity includes any of retinopathy of prematurity stage ≥3 , intraventricular haemorrhage grade ≥3 , cystic periventricular leucomalacia or severe bronchopulmonary dysplasia (need for at least 30% oxygen at 36 weeks of corrected age).
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References

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