2004 - 2007年与2014 - 2016年瑞典极早产分娩的集中化及出生后早期死亡率的降低

Centralisation of extremely preterm births and decreased early postnatal mortality in Sweden, 2004-2007 versus 2014-2016.

作者信息

Gadsbøll Christian, Björklund Lars J, Norman Mikael, Abrahamsson Thomas, Domellöf Magnus, Elfvin Anders, Farooqi Aijaz, Hellström-Westas Lena, Håkansson Stellan, Källén Karin, Normann Erik, Serenius Fredrik, Sävman Karin, Um-Bergström Petra, Ådén Ulrika, Ley David

机构信息

Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.

Skåne University Hospital, Lund, Sweden.

出版信息

Acta Paediatr. 2025 Feb;114(2):319-331. doi: 10.1111/apa.17429. Epub 2024 Sep 23.

DOI:10.1111/apa.17429

PMID:39313908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11706746/

Abstract

AIM

We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity.

METHODS

Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004-2007 and 2014-2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes.

RESULTS

Among 1626 liveborn infants, 703 were born in 2004-2007 and 923 in 2014-2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31-3.07, p = 0.001). The higher 1-year mortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3-4 than inborn infants (22% vs. 14% in 2004-2007, and 22% vs. 13% in 2014-2016, both p < 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%-40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88).

CONCLUSION

Centralisation of EPT births contributed to a lower 1-year mortality in 2014-2016 than that in 2004-2007, attributed to a decrease in deaths before 24 h among inborn infants.

摘要

目的

我们评估了瑞典极早产儿（EPT）出生集中化程度的增加与死亡率和发病率变化之间的关系。

方法

分析2004 - 2007年和2014 - 2016年瑞典妊娠22 + 0至26 + 6周活产儿的基于人群的数据，以研究时间段、在区域中心内（本地出生）或外（外地出生）出生与结局之间的关联。

结果

在1626名活产婴儿中，703名在2004 - 2007年出生，923名在2014 - 2016年出生。即使在对出生队列、胎龄、出生体重标准差评分和婴儿性别进行调整后，在区域中心外（与中心内相比）出生的婴儿死亡率仍较高（调整后的优势比为2.01，95%置信区间为1.31 - 3.07，p = 0.001）。外地出生婴儿较高的1年死亡率主要是由于出生后24小时内死亡人数较多。外地出生婴儿3 - 4级脑室内出血的发生率高于本地出生婴儿（2004 - 2007年分别为22%和14%，2014 - 2016年分别为22%和13%，p均<0.05）。虽然本地出生婴儿1岁时无严重疾病存活的比例有所增加（从33%增至40%，p = 0.008），但外地出生婴儿这一比例保持不变（分别为29%和30%，p = 0.88）。