Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study.

Adams, Mark; Berger, Thomas M; Borradori-Tolsa, Cristina; Bickle-Graz, Myriam; Grunt, Sebastian; Gerull, Roland; Bassler, Dirk; Natalucci, Giancarlo (2019). Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study. BMJ open, 9(3), e024560. BMJ Publishing Group 10.1136/bmjopen-2018-024560

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OBJECTIVES To investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22-25 and cohort B born at 26-27 gestational weeks, respectively. DESIGN Geographically defined, retrospective cohort study. SETTING All nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland. PATIENTS All live-born infants in Switzerland in 2006-2013 below 28 gestational weeks, excluding infants with major congenital malformation. OUTCOME MEASURES Outcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI). RESULTS Cohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A. CONCLUSIONS Centres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Neuropaediatrics

UniBE Contributor:

Grunt, Sebastian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Karen Lidzba

Date Deposited:

25 Jun 2019 13:27

Last Modified:

22 Oct 2019 18:28

Publisher DOI:

10.1136/bmjopen-2018-024560

PubMed ID:

30878980

Uncontrolled Keywords:

fetal medicine neonatology quality in health care

BORIS DOI:

10.7892/boris.129892

URI:

https://boris.unibe.ch/id/eprint/129892

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