Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation

Objective To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation. Study design Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of an...

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Bibliographic Details
Published in:	Journal of perinatology Vol. 39; no. 1; pp. 39 - 47
Main Authors:	Backes, Carl H., Söderström, Fanny, Ågren, Johan, Sindelar, Richard, Bartlett, Christopher W., Rivera, Brian K., Mitchell, Courtney C., Frey, Heather A., Shepherd, Edward G., Nelin, Leif D., Normann, Erik
Format:	Journal Article
Language:	English
Published:	New York Nature Publishing Group US 01-01-2019 Nature Publishing Group
Subjects:	692/308/409 692/700/1720 Adult Babies Care and treatment Children Cohort Studies Comparative analysis Corticoids Corticosteroid drugs Corticosteroids Evidence-based medicine Female Gestation Gestational Age Glucocorticoids - therapeutic use Health aspects Humans Infant Infant Mortality Infant, Extremely Premature Infant, Newborn Infant, Newborn, Diseases - etiology Infant, Newborn, Diseases - mortality Infant, Newborn, Diseases - therapy Infants Intensive Care, Neonatal - methods Intensive Care, Neonatal - statistics & numerical data Male Medicine Medicine & Public Health Methods Neonatal intensive care Neonates Newborn infants Patient outcomes Pediatric Surgery Pediatrics Pediatrik Pregnancy Pregnancy Outcome - epidemiology Premature infants Prenatal Care - methods Prenatal Care - statistics & numerical data Resuscitation Resuscitation - statistics & numerical data Retrospective Studies Steroids (Organic compounds) Subgroups Survival Survival Rate Sweden - epidemiology United States - epidemiology United States Sweden
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Summary:	Objective To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation. Study design Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated. Result Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05). Conclusion Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0743-8346 1476-5543 1476-5543
DOI:	10.1038/s41372-018-0248-y