title: Changes in care and short-term outcome for very preterm infants in Estonia.
abstract: OBJECTIVE
  To identify recent changes in short-term outcome and care for very preterm infants in Estonia.
  
  
  METHODS
  Comparison of two population-based cohort of very preterm infants born alive at 22-31 gestational weeks. In 2007-2008, data were recorded prospectively in a neonatal register. For the cohort born in 2002-2003, the same variables were extracted retrospectively from the hospital records. Infants were followed up to discharge or death.
  
  
  RESULTS
  The cohort of 2007-2008 contained a higher proportion of infants born by caesarean section and of infants who received antenatal corticosteroids, maternal antibiotics, or surfactant therapy than the earlier cohort. A higher proportion of infants was admitted for care in 2007-2008 (98% vs. 94%; p = 0.013). During the study period, survival until discharge increased (85% vs. 78%; p = 0.041), although the length of hospital stay was unchanged. The use of mechanical ventilation, inotropes, and postnatal antibiotics decreased. Neonatal morbidity remained unchanged, except for a decrease in severe periventricular/intraventricular haemorrhage.
  
  
  CONCLUSIONS
  The outcome for very preterm infants in Estonia has improved since 2002. With proactive perinatal management and less invasive neonatal care, survival until discharge increased without concomitant increases in neonatal morbidity and the length of hospital stay.
authors.affiliation: Department of Paediatrics, University of Tartu, Tartu, Estonia. liis.toome@lastehaigla.ee
authors.forename: Liis
authors.initials: L
authors.lastname: Toome
authors.forename: Inge
authors.initials: I
authors.lastname: Ringmets
authors.forename: Pille
authors.initials: P
authors.lastname: Andresson
authors.forename: Mari-Liis
authors.initials: ML
authors.lastname: Ilmoja
authors.forename: Pille
authors.initials: P
authors.lastname: Saik
authors.forename: Heili
authors.initials: H
authors.lastname: Varendi
mesh_terms: D015331:Cohort Studies; D004957:Estonia; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D018743:Perinatal Care / Q000379:methods*; D015996:Survival Rate / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome