Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study. Issue 3 (15th March 2019)

• Record Type: Journal Article
• Authors: Adams, Mark; Berger, Thomas M; Borradori-Tolsa, Cristina; Bickle-Graz, Myriam; Grunt, Sebastian; Gerull, Roland; Bassler, Dirk; Natalucci, Giancarlo
• Other Names: author non-byline.; Anderegg Meyer C author non-byline.; Mori A Capone author non-byline.; Kaeppeli D author non-byline.; Schulzke S author non-byline.; Weber P author non-byline.; Ramelli G P author non-byline.; Simonetti B Goeggel author non-byline.; Nelle M author non-byline.; Wagner B author non-byline.; Steinlin M author non-byline.; Grunt S author non-byline.; Gebauer M author non-byline.; Hassink R author non-byline.; Bär W author non-byline.; Keller E author non-byline.; Killer Ch author non-byline.; Fuhrer K author non-byline.; Pfister R E author non-byline.; Hüppi P S author non-byline.; Borradori-Tolsa C author non-byline.; Tolsa J-F author non-byline.; Roth-kleiner M author non-byline.; Bickle-graz M author non-byline.; Berger T M author non-byline.; Schmitt-Mechelke T author non-byline.; Bauder F author non-byline.; Pezzoli V author non-byline.; Erkert B author non-byline.; Mueller A author non-byline.; Ecoffey M author non-byline.; Malzacher A author non-byline.; Micallef J P author non-byline.; Lang-Dullenkopf A author non-byline.; Hegi L author non-byline.; Rhein M Von author non-byline.; Bassler D author non-byline.; Arlettaz R author non-byline.; Bernet V author non-byline.; Latal B author non-byline.; Natalucci G author non-byline.; Moenkhoff M author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 3(2019)
• Publication Date: 2019-03-15
• Subjects: neonatology -- fetal medicine -- quality in health care; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-024560
• Languages: English
• ISSNs: 2044-6055

Abstract

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.