title: Intensity of perinatal care for extremely preterm infants: outcomes at 2.5 years.
abstract: OBJECTIVE
  To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (<27 weeks) born in Sweden during 2004-2007.
  
  
  METHODS
  A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission.
  
  
  RESULTS
  Each 5-point increment in GA-specific activity score reduced the stillbirth risk (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.83-0.97) and the 1-year mortality risk (aOR: 0.84; 95% CI: 0.78-0.91) in the primary population and the 1-year mortality risk in live-born infants (aOR: 0.86; 95% CI: 0.79-0.93). In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22- to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA.
  
  
  CONCLUSIONS
  Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden; fredrik.serenius@kbh.uu.se.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Serenius
authors.affiliation: Department of Pediatrics, Karolinska University Hospital, Huddinge, Stockholm, Sweden;
authors.forename: Mats
authors.initials: M
authors.lastname: Blennow
authors.affiliation: Department of Obstetrics and Gynecology, Lund University, Lund, Sweden;
authors.forename: Karel
authors.initials: K
authors.lastname: Maršál
authors.affiliation: Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden; and.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sjörs
authors.affiliation: Centre for Reproductive Epidemiology, Lund University, Lund, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Källen
mesh_terms: D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology / Q000517:prevention & control*; D018743:Perinatal Care / Q000592:standards*; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
keywords: cohort study; extremely preterm infants; mortality rates; neurodevelopmental outcome