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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; Swiss Neonatal Network; Follow-up Group (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.

Abstract

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.

Abstract

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neonatology
04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:15 March 2019
Deposited On:24 May 2019 13:01
Last Modified:27 Jan 2020 14:26
Publisher:BMJ Publishing Group
ISSN:2044-6055
OA Status:Gold
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1136/bmjopen-2018-024560
PubMed ID:30878980

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