Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden.
Acta Paediatr. 2023 Jul;112(7):1422-1433. doi: 10.1111/apa.16753. Epub 2023 Mar 21.
Organisation of care, perinatal and neonatal management of very preterm infants in the Nordic regions were hypothesised to vary significantly. The aim of this observational study was to test this hypothesis.
Information on preterm infants in the 21 greater healthcare regions of Denmark, Finland, Iceland, Norway and Sweden was gathered from national registers in 2021. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very (<32 weeks) and extremely preterm infants (<28 weeks of gestational age) were compared.
Out of 287 642 infants born alive, 16 567 (5.8%) were preterm, 2389 (0.83%) very preterm and 800 (0.28%) were extremely preterm. In very preterm infants, exposure to antenatal corticosteroids varied from 85% to 98%, live births occurring at regional centres from 48% to 100%, surfactant treatment from 28% to 69% and use of mechanical ventilation varied from 13% to 77% (p < 0.05 for all comparisons). Significant regional variations within and between countries were also seen in capacity in neonatal care, case-mix and number of admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities.
Management of very preterm infants exhibited significant regional variations in the Nordic countries.
北欧地区的早产儿照护组织和围产儿及新生儿管理被假设存在显著差异。本观察性研究旨在检验这一假设。
2021 年，从丹麦、芬兰、冰岛、挪威和瑞典的 21 个更大的医疗保健地区的国家登记处收集了早产儿的信息。比较了非常早产（<32 周）和极早产（<28 周的胎龄）婴儿的早产率、病例组合、围产期干预、新生儿发病率和存活率。
在 287642 名活产婴儿中，有 16567 名（5.8%）为早产儿，2389 名（0.83%）为非常早产儿，800 名（0.28%）为极早产儿。在非常早产儿中，产前皮质激素的暴露率从 85%到 98%不等，活产发生在区域中心的比例从 48%到 100%不等，表面活性剂治疗的比例从 28%到 69%不等，机械通气的使用率从 13%到 77%不等（所有比较均为 p<0.05）。在新生儿护理能力、病例组合和入院人数方面，国家内部和国家之间也存在显著的区域差异，而存活率或主要新生儿发病率没有统计学差异。
北欧国家的早产儿管理存在显著的区域差异。
