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

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_B2365355C478
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study.
Journal
BMJ open
Author(s)
Adams M., Berger T.M., Borradori-Tolsa C., Bickle-Graz M., Grunt S., Gerull R., Bassler D., Natalucci G.
Working group(s)
Swiss Neonatal Network & Follow-Up Group
Contributor(s)
Anderegg M.C., Mori A.C., Kaeppeli D., Schulzke S., Weber P., Ramelli G.P., Simonetti B.G., Nelle M., Wagner B., Steinlin M., Grunt S., Gebauer M., Hassink R., Bär W., Keller E., Killer C., Fuhrer K., Pfister R.E., Hüppi P.S., Borradori-Tolsa C., Tolsa J.F., Roth-Kleiner M., Bickle-Graz M., Berger T.M., Schmitt-Mechelke T., Bauder F., Pezzoli V., Erkert B., Mueller A., Ecoffey M., Malzacher A., Micallef J.P., Lang-Dullenkopf A., Hegi L., Rhein M.V., Bassler D., Arlettaz R., Bernet V., Latal B., Natalucci G., Moenkhoff M.
ISSN
2044-6055 (Electronic)
ISSN-L
2044-6055
Publication state
Published
Issued date
15/03/2019
Peer-reviewed
Oui
Volume
9
Number
3
Pages
e024560
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
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.
Geographically defined, retrospective cohort study.
All nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland.
All live-born infants in Switzerland in 2006-2013 below 28 gestational weeks, excluding infants with major congenital malformation.
Outcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI).
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.
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.
Keywords
Child, Preschool, Developmental Disabilities/epidemiology, Female, Gestational Age, Humans, Infant, Infant Mortality, Infant, Extremely Premature, Infant, Newborn, Intensive Care Units, Neonatal/standards, Length of Stay/statistics & numerical data, Male, Perinatal Care/standards, Retrospective Studies, Switzerland/epidemiology, fetal medicine, neonatology, quality in health care
Pubmed
Web of science
Open Access
Yes
Create date
10/04/2019 17:36
Last modification date
05/04/2020 6:20
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