Birth outcomes between 22 and 26 weeks' gestation in national population‐based cohorts from Sweden, England and France
Morgan, Andrei S.; Zeitlin, Jennifer; Källén, Karin; Draper, Elizabeth S.; Maršál, Karel; Norman, Mikael; Serenius, Fredrik; Buuren, Stef; Johnson, Samantha; Benhammou, Valérie; Pierrat, Véronique; Kaminski, Monique; L'Helias, Laurence Foix; Ancel, Pierre‐Yves; Marlow, Neil
(2022) Acta Paediatrica, volume 111, issue 1, pp. 59 - 75
(Article)
Abstract
Aim: We investigated the timing of survival differences and effects on morbidity for foetuses alive at maternal admission to hospital delivered at 22 to 26 weeks’ gestational age (GA). Methods: Data from the EXPRESS (Sweden, 2004–07), EPICure-2 (England, 2006) and EPIPAGE-2 (France, 2011) cohorts were harmonised. Survival, stratified by GA, was
... read more
analysed to 112 days using Kaplan-Meier analyses and Cox regression adjusted for population and pregnancy characteristics; neonatal morbidities, survival to discharge and follow-up and outcomes at 2–3 years of age were compared. Results: Among 769 EXPRESS, 2310 EPICure-2 and 1359 EPIPAGE-2 foetuses, 112-day survival was, respectively, 28.2%, 10.8% and 0.5% at 22–23 weeks’ GA; 68.5%, 40.0% and 23.6% at 24 weeks; 80.5%, 64.8% and 56.9% at 25 weeks; and 86.6%, 77.1% and 74.4% at 26 weeks. Deaths were most marked in EPIPAGE-2 before 1 day at 22–23 and 24 weeks GA. At 25 weeks, survival varied before 28 days; differences at 26 weeks were minimal. Cox analyses were consistent with the Kaplan-Meier analyses. Variations in morbidities were not clearly associated with survival. Conclusion: Differences in survival and morbidity outcomes for extremely preterm births are evident despite adjustment for background characteristics. No clear relationship was identified between early mortality and later patterns of morbidity.
show less
Download/Full Text
Keywords: epidemiology, extreme preterm birth, international comparisons, neonatal, perinatal, survival analysis
ISSN: 0803-5253
Publisher: Blackwell Publishing Ltd
Note: Funding Information: All authors have completed ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author). ASM, JZ, KK, ESD, SvB, SJ, VB, VP and PYA report grants from H2020/European Union during the conduct of this study; MN reports grants from Stockholm County Council and Karolinksa Institutet (ALF 2020‐0443) during the conduct of this study, and personal fees from AbbVie and Chiesi Pharma AB; and NM reports grants from the Medical Research Council during the conduct of the study, and personal fees from Novartis, Takeda and RSM Consulting outside the submitted work. All other authors report no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years. Funding Information: This project was funded by the European Union's Horizon 2020 Research and Innovation Program (RECAP Preterm Project, grant no. 733280) (ASM, JZ, KK, ESD, SvB, SJ, VP, VB and PYA). ASM additionally received part funding from the Fondation pour la Recherche Médicale (reference SPF20160936356), and NM receives part funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme at UCLH/UCL. The EXPRESS cohort study was supported by the Swedish Research Council grants 2006‐3855 and 2009‐4250, the Uppsala‐Örebro Regional Research Council grant RFR‐10324, a grant from the Research Council South East Region of Sweden, and grants to Researchers in the Public Health Care from the Swedish government. Financial support was also provided through a regional agreement between the University of UmeÃ… and VÃ, sterbotten County Council and through a regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet. The study also received support from The ‘Lilla Barnets Fond’ Children’s fund, the Evy and Gunnar Sandberg and the Birgit and Håkan Ohlsson Foundations, and from the Marie Curie Individual Intra‐European Fellowship within the EU FP6 Framework Program. The EPICure‐2 cohort was funded by the Medical Research Council (G0401525). The EPIPAGE‐2 cohort has been funded with support from the French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer, and the National Solidarity Fund for Autonomy (CNSA); the National Research Agency, through the French EQUIPEX programme of investments in the future (reference ANR‐11‐EQPX‐0038); the PREMUP Foundation; and Fondation de France (reference 00050329). The funders had no role in study design, data collection, data analysis, data interpretation, decision to publish or preparation of the manuscript. Funding Information: This project was funded by the European Union's Horizon 2020 Research and Innovation Program (RECAP Preterm Project, grant no. 733280) (ASM, JZ, KK, ESD, SvB, SJ, VP, VB and PYA). ASM additionally received part funding from the Fondation pour la Recherche M?dicale (reference SPF20160936356), and NM receives part funding from the Department of Health?s NIHR Biomedical Research Centre?s funding scheme at UCLH/UCL. The EXPRESS cohort study was supported by the Swedish Research Council grants 2006-3855 and 2009-4250, the Uppsala-?rebro Regional Research Council grant RFR-10324, a grant from the Research Council South East Region of Sweden, and grants to Researchers in the Public Health Care from the Swedish government. Financial support was also provided through a regional agreement between the University of Ume? and V?sterbotten County Council and through a regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet. The study also received support from The ?Lilla Barnets Fond? Children?s fund, the Evy and Gunnar Sandberg and the Birgit and H?kan Ohlsson Foundations, and from the Marie Curie Individual Intra-European Fellowship within the EU FP6 Framework Program. The EPICure-2 cohort was funded by the Medical Research Council (G0401525). The EPIPAGE-2 cohort has been funded with support from the French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer, and the National Solidarity Fund for Autonomy (CNSA); the National Research Agency, through the French EQUIPEX programme of investments in the future (reference ANR-11-EQPX-0038); the PREMUP Foundation; and Fondation de France (reference 00050329). The funders had no role in study design, data collection, data analysis, data interpretation, decision to publish or preparation of the manuscript. Publisher Copyright: © 2021 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.
(Peer reviewed)
