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Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS)

Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS)
Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS)
Introduction: A population-based observational study investigated the contribution of obstetric factors to the survival and postnatal development of extremely preterm infants.

Material and methods: Mortality up to 1 year and neurodevelopment at 2.5 years (Bayley-III test, cerebral palsy, vision, hearing) were evaluated in infants born before 27 weeks of gestation in Sweden 2004–2007 (n = 1011), using logistic regression analyses of risk factors.

Results: Of 844 fetuses alive at admission, 8.4% died in utero before labor, 7.8% died intrapartum. Of 707 live-born infants, 15% died within 24 h, 70% survived ?365 days, 64% were assessed at 2.5 years. The risk of death within 24 h after birth decreased with gestational age [odds ratio (OR) 0.3; 95% CI 0.2–0.4], antenatal corticosteroids (OR 0.3; 95% CI 0.1–0.6), and cesarean section (OR 0.4; 95% CI 0.2–0.9); it increased with multiple birth (OR 3.0; 95% CI 1.5–6.0), vaginal breech delivery (OR 2.3; 95% CI 1.0–5.1), 5-min Apgar score <4 (OR 50.4; 95% CI 28.2–90.2), and birth at a level II hospital (OR 2.6; 95% CI 1.2–5.3). The risk of death between 1 and 365 days remained significantly decreased for gestational age and corticosteroids. The risk of mental developmental delay at 2.5 years decreased with gestational age, birthweight and fetal growth; it increased with vaginal breech delivery (OR 2.0; 95% CI 1.2–7.4), male gender, low Apgar score and high Clinical Risk Index for Babies score.

Conclusion: Several obstetric factors, including abdominal delivery, influenced the risk of death within the first day of life, but not later. Antenatal corticosteroids and gestational age decreased the mortality up to 1 year. Mental developmental delay was related to vaginal breech delivery.
extremely preterm birth, mortality, risk factors, obstetric interventions, neaurodevelopmental outcome, cesarean section, breech
1203-1214
Källén, Karin
59e12ec5-ecb6-4daf-9a1c-be64f2713221
Serenius, Fredrik
63f42df3-486d-4dab-bbbe-e335fc97d645
Westgren, Magnus
ad9460b1-bf01-4c0e-8e7b-f7d17bb2dd39
Maršál, Karel
8dede649-0c85-4833-9692-9f2bfd860fe8
Källén, Karin
59e12ec5-ecb6-4daf-9a1c-be64f2713221
Serenius, Fredrik
63f42df3-486d-4dab-bbbe-e335fc97d645
Westgren, Magnus
ad9460b1-bf01-4c0e-8e7b-f7d17bb2dd39
Maršál, Karel
8dede649-0c85-4833-9692-9f2bfd860fe8

Källén, Karin, Serenius, Fredrik and Westgren, Magnus et al. (2015) Impact of obstetric factors on outcome of extremely preterm births in Sweden: prospective population-based observational study (EXPRESS). Acta Obstetricia et Gynecologica Scandinavica, 94 (11), 1203-1214. (doi:10.1111/aogs.12726). (PMID:26249263)

Record type: Article

Abstract

Introduction: A population-based observational study investigated the contribution of obstetric factors to the survival and postnatal development of extremely preterm infants.

Material and methods: Mortality up to 1 year and neurodevelopment at 2.5 years (Bayley-III test, cerebral palsy, vision, hearing) were evaluated in infants born before 27 weeks of gestation in Sweden 2004–2007 (n = 1011), using logistic regression analyses of risk factors.

Results: Of 844 fetuses alive at admission, 8.4% died in utero before labor, 7.8% died intrapartum. Of 707 live-born infants, 15% died within 24 h, 70% survived ?365 days, 64% were assessed at 2.5 years. The risk of death within 24 h after birth decreased with gestational age [odds ratio (OR) 0.3; 95% CI 0.2–0.4], antenatal corticosteroids (OR 0.3; 95% CI 0.1–0.6), and cesarean section (OR 0.4; 95% CI 0.2–0.9); it increased with multiple birth (OR 3.0; 95% CI 1.5–6.0), vaginal breech delivery (OR 2.3; 95% CI 1.0–5.1), 5-min Apgar score <4 (OR 50.4; 95% CI 28.2–90.2), and birth at a level II hospital (OR 2.6; 95% CI 1.2–5.3). The risk of death between 1 and 365 days remained significantly decreased for gestational age and corticosteroids. The risk of mental developmental delay at 2.5 years decreased with gestational age, birthweight and fetal growth; it increased with vaginal breech delivery (OR 2.0; 95% CI 1.2–7.4), male gender, low Apgar score and high Clinical Risk Index for Babies score.

Conclusion: Several obstetric factors, including abdominal delivery, influenced the risk of death within the first day of life, but not later. Antenatal corticosteroids and gestational age decreased the mortality up to 1 year. Mental developmental delay was related to vaginal breech delivery.

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More information

Accepted/In Press date: 31 July 2015
e-pub ahead of print date: 7 September 2015
Published date: November 2015
Keywords: extremely preterm birth, mortality, risk factors, obstetric interventions, neaurodevelopmental outcome, cesarean section, breech
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 389657
URI: https://eprints.soton.ac.uk/id/eprint/389657
PURE UUID: 4691d4ff-728c-4d6c-9746-42fadefc33e1

Catalogue record

Date deposited: 11 Mar 2016 11:39
Last modified: 09 Aug 2017 16:31

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