title: Improvement in perinatal care for extremely premature infants in Denmark from 1994 to 2011.
abstract: BACKGROUND
  Major advances in perinatal care over the latest decades have increased the survival rate of extremely premature infants. Centralisation of perinatal care was implemented in Denmark from 1995. This study evaluates the effect of organisational changes of perinatal care on survival and morbidity of live-born infants with gestational ages (GA) of 22-28 weeks.
  
  
  METHODS
  Three cohort studies were included from 1994-1995, 2003 and 2011. Data from live-born infants were extracted regarding risk factors, survival, bronchopulmonary dysplasia (BPD), cystic periventricular leukomalacia (cPVL) and intraventricular haemorrhage grade 3-4 (IVH 3-4).
  
  
  RESULTS
  A total of 184, 83 and 127 infants were included from the cohorts. Delivery rates at level 3 Neonatal Intensive Care Unit (NICU) hospitals increased from 69% to 87%. Transfer rates to level 3 NICU almost doubled during the period. Survival rates were stationary, although a trend towards increased survival was observed for infants < 26 weeks. The frequency of infants receiving evidence-based treatment increased from 14% to 46%. IVH 3-4 rates were reduced from 21% to 12%, whereas BPD and cPVL rates did not change. Survival odds increased with higher gestational age and administration of surfactant.
  
  
  CONCLUSIONS
  Centralisation of treatment of extremely premature infants has been implemented because more children are being born at highly specialised perinatal centres. Care improved as more infants received evidence-based treatment. IVH 3-4 rates declined. A trend towards increased survival was observed for infants with a GA < 26 weeks.
  
  
  BACKGROUND
  none.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: ahasselager@dadlnet.dk.
authors.forename: Asbjørn Børch
authors.initials: AB
authors.lastname: Hasselager
authors.forename: Klaus
authors.initials: K
authors.lastname: Børch
authors.forename: Ole Axel
authors.initials: OA
authors.lastname: Pryds
mesh_terms: D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality; D015931:Intensive Care, Neonatal / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D018743:Perinatal Care / Q000379:methods / Q000592:standards / Q000639:trends; D011247:Pregnancy; D058996:Quality Improvement; D012307:Risk Factors