Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study.
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
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
15 03 2019
15 03 2019
Historique:
entrez:
18
3
2019
pubmed:
18
3
2019
medline:
17
3
2020
Statut:
epublish
Résumé
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.
Identifiants
pubmed: 30878980
pii: bmjopen-2018-024560
doi: 10.1136/bmjopen-2018-024560
pmc: PMC6429852
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e024560Investigateurs
Meyer C Anderegg
(MC)
A Capone Mori
(AC)
D Kaeppeli
(D)
S Schulzke
(S)
P Weber
(P)
G P Ramelli
(GP)
B Goeggel Simonetti
(BG)
M Nelle
(M)
B Wagner
(B)
M Steinlin
(M)
S Grunt
(S)
M Gebauer
(M)
R Hassink
(R)
W Bär
(W)
E Keller
(E)
Ch Killer
(C)
K Fuhrer
(K)
R E Pfister
(RE)
P S Hüppi
(PS)
C Borradori-Tolsa
(C)
J-F Tolsa
(JF)
M Roth-Kleiner
(M)
M Bickle-Graz
(M)
T M Berger
(TM)
T Schmitt-Mechelke
(T)
F Bauder
(F)
V Pezzoli
(V)
B Erkert
(B)
A Mueller
(A)
M Ecoffey
(M)
A Malzacher
(A)
J P Micallef
(JP)
A Lang-Dullenkopf
(A)
L Hegi
(L)
M Von Rhein
(MV)
D Bassler
(D)
R Arlettaz
(R)
V Bernet
(V)
B Latal
(B)
G Natalucci
(G)
M Moenkhoff
(M)
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: MA receives a salary as network coordinator for the Swiss Neonatal Network.
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