Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
Abstract
:1. Introduction
Aim
2. Material and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
- Chawanpaiboon, S.; Vogel, J.P.; Moller, A.B.; Lumbiganon, P.; Petzold, M.; Hogan, D.; Landoulsi, S.; Jampathong, N.; Kongwattanakul, K.; Laopaiboon, M.; et al. Global, regional and national estimates of levels of preterm birth in 2014: A systematic review and modeling analysis. Lancet Glob. Health 2019, 7, e37–e46. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cobo, T.; Kacerovsky, M.; Jacobsson, B. Risk factors for spontaneous preterm birth. Int. J. Obstet. Gynecol. 2020, 150, 17–23. [Google Scholar] [CrossRef] [PubMed]
- Norman, J. Progesterone and preterm birth. Obstet. Gynecol. 2020, 15, 24–30. [Google Scholar] [CrossRef]
- Di Renzo, G.C.; Tosto, V.; Giardina, I. The biological basis and prevention of preterm birth. Best Pract. Res. Clin. Obstet. Gynaecol. 2018, 52, 13–22. [Google Scholar] [CrossRef] [PubMed]
- Yellon, S.M. Immunobiology of Cervix Ripening. Front. Immunol. 2020, 10, 3156. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fettweis, J.M.; Serrano, M.G.; Brooks, J.P.; Edwards, D.J.; Girerd, P.H.; Parikh, H.I.; Huang, B.; Arodz, T.J.; Edupuganti, L.; Glascock, A.L.; et al. The vaginal microbiome and preterm birth. Nat. Med. 2019, 25, 1012–1021. [Google Scholar] [CrossRef] [Green Version]
- Bayar, E.; Bennett, P.R.; Chan, D.; Sykes, L.; MacIntyre, D.A. The pregnancy microbiome and preterm birth. Semin. Immunopathol. 2020, 42, 487–499. [Google Scholar] [CrossRef]
- Vladic Stjernholm, Y.; Vladic, T.; Marchini, G. Progesterone Gel and Placebo Prolonged Pregnancy More Effectively Than Intravenous Tocolysis Alone in Women with Preterm Labor. Gels 2022, 8, 272. [Google Scholar] [CrossRef] [PubMed]
- Lamont, R.F.; Jørgensen, J.S. Safety and Efficacy of Tocolytics for the Treatment of Spontaneous Preterm Labour. Curr. Pharm. Des. 2019, 25, 577–592. [Google Scholar] [CrossRef] [PubMed]
- Shennan, A.; Suff, N.; Leigh Simpson, J.; Jacobsson, B.; Mol, B.W.; Grobman, W.A.; The FIGO Working Group for Preterm Birth. FIGO good practice recommendations on progestogens for prevention of preterm delivery. Int. J. Gynecol. Obstet. 2021, 155, 16–18. [Google Scholar] [CrossRef]
- Padilla, N.; Eklöf, E.; Mårtensson, G.E.; Bölte, S.; Lagercrantz, H.; Ådén, U. Poor Brain Growth in Extremely Preterm Neonates Long Before the Onset of Autism Spectrum Disorder Symptoms. Cereb. Cortex 2017, 27, 1245–1252. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Moore, T.; Hennessy, E.M.; Myles, J.; Johnson, S.J.; Draper, E.S.; Costeloe, K.L.; Marlow, N. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: The EPICure studies. BMJ 2012, 345, e7961. [Google Scholar] [CrossRef] [Green Version]
- Ishi, N.; Kono, Y.; Yonemoto, N.; Kusuda, S.; Fujimura, M. Neonatal Research Network, Japan. Outcomes of infants born at 22 and 23 weeks’ gestation. Pediatrics 2013, 132, 62–71. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Serenius, F.; Ewald, U.; Farooqi, A.; Fellman, V.; Hafström, M.; Hellgren, K.; Maršál, K.; Ohlin, A.; Olhager, E.; Stjernqvist, K.; et al. Neurodevelopmental outcomes among extremely preterm infants 6.5 years after active perinatal care in Sweden. JAMA Pediatr. 2016, 170, 954–963. [Google Scholar] [CrossRef] [Green Version]
- Allotey, J.; Zamora, J.; Cheong-See, F.; Kalidindi, M.; Arroyo-Manzano, D.; Asztalos, E.; van der Post, J.; Mol, B.W.; Moore, D.; Birtles, D.; et al. Cognitive, motor, behavioural and academic performances of children born preterm: A meta-analysis and systematic review involving 64 061 children. BJOG 2018, 125, 16–25. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Myrhaug, H.T.; Brurberg, K.G.; Hov, L.; Markestad, T. Survival and impairment of extremely premature infants: A meta-analysis. Pediatrics 2019, 143, e20180933. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Norman, M.; Hallberg, B.; Abrahamsson, T.; Björklund, L.J.; Domellöf, M.; Farooqi, A.; Foyn Bruun, C.; Gadsbøll, C.; Hellström-Westas, L.; Ingemansson, F.; et al. Association between Year of Birth and 1-Year Survival among Extremely Preterm Infants in Sweden during 2004–2007 and 2014–2016. JAMA 2019, 321, 1188–1199. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Morsing, E.; Lundgren, P.; Hård, A.L.; Rakow, A.; Hellström-Westas, L.; Jacobson, L.; Johnson, M.; Nilsson, S.; Smith LE, H.; Sävman, K.; et al. Neurodevelopmental disorders and somatic diagnoses in a national cohort of children born before 24 weeks of gestation. Acta Paediatr. 2022, 111, 1167–1175. [Google Scholar] [CrossRef]
- The National Board of Health and Welfare (Socialstyrelsen). The National Board of Health and Welfare (Socialstyrelsen). Vård av Extremt Prematura Barn. Available online: https://www.socialstyrelsen.se/ (accessed on 14 December 2020).
- World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
- Domellöf, M.; Jonsson, B. The Swedish approach to management of extreme prematurity at the borderline of viability: A historical and ethical perspective. Pediatrics 2018, 142 (Suppl. S1), S533–S538. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. International Classification of Functioning, Disability and Health. Children & Youth Version (ICF-CY); World Health Organization: Geneva, Switzerland, 2007. [Google Scholar]
- Bayley, N. Bayley Scales of Infant and Toddler Development, 3rd ed.; Harcourt Assessment Inc.: San Antonio, TX, USA, 2006. [Google Scholar]
- Albrechtsen, S.; Rasmussen, S.; Thoresen, S.; Irgens, L.M.; Iversen, O.E. Pregnancy outcome in women before and after cervical conisation: Population based cohort study. BMJ 2008, 337, a1343. [Google Scholar] [CrossRef] [Green Version]
- Kindinger, L.M.; Kyrgiou, M.; MacIntyre, D.A.; Cacciatore, S.; Yulia, A.; Cook, J.; Terzidou, V.; Teoh, T.G.; Bennett, P.R. Preterm Birth Prevention Post-Conization: A Model of Cervical Length Screening with Targeted Cerclage. PLoS ONE 2016, 11, e0163793. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lueth, A.; Blue, N.; Silver, R.M.; Allshouse, A.; Hoffman, M.; Grobman, W.A.; Simhan, H.N.; Reddy, U.; Haas, D.M. Prospective evaluation of placental abruption in nulliparous women. J. Matern. Fetal Neonatal Med. 2022, 35, 8603–8610. [Google Scholar] [CrossRef]
- Jain, V.G.; Willis, K.A.; Jobe, A.; Ambalavanan, N. Chorioamnionitis and neonatal outcomes. Pediatr. Res. 2022, 2, 289–296. [Google Scholar] [CrossRef] [PubMed]
- Kim, C.J.; Romero, R.; Chaemsaithong, P.; Chaiyasit, N.; Yoon, B.H.; Kim, Y.M. Acute chorioamnionitis and funisitis: Definition, pathologic features, and clinical significance. Am. J. Obstet. Gynecol. 2015, 213, S29–S52. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nuriel-Ohayon, M.; Neuman, H.; Koren, O. Microbial changes during pregnancy, birth, and infancy. Front. Microbiol. 2016, 7, 1031. [Google Scholar] [CrossRef] [Green Version]
- Baraldi, E.; Allodi, M.W.; Smedler, A.C.; Westrup, B.; Löwing, K.; Ådén, U. Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact. Int. J. Environ. Res. Public Health 2020, 17, 9326. [Google Scholar] [CrossRef]
- Gath, M.E.; Lee, S.J.; Austin, N.C.; Woodward, L.J. Increased Risk of Parental Instability for Children Born Very Preterm and Impacts on Neurodevelopmental Outcomes at Age 12. Children 2022, 9, 304. [Google Scholar] [CrossRef]
- Verloove-Vanhorick, S.P. Management of the neonate at the limits of viability: The Dutch viewpoint. BJOG 2006, 113 (Suppl. S3), 13–16. [Google Scholar] [CrossRef]
- Verhagen, A.A. Why Do Neonatologists in Scandinavian Countries and the Netherlands Make Life-and-death Decisions So Different? Pediatrics 2018, 142 (Suppl. S1), S585–S589. [Google Scholar] [CrossRef] [Green Version]
- Guillén, Ú.; Weiss, E.M.; Munson, D.; Maton, P.; Jefferies, A.; Norman, M.; Naulaers, G.; Mendes, J.; Justo da Silva, L.; Zoban, P.; et al. Guidelines for the management of extremely premature deliveries: A systematic review. Pediatrics 2015, 136, 343–350. [Google Scholar] [CrossRef] [Green Version]
Variable | 2009–2015 n = 108 | 2016–2019 n = 77 | p Value |
---|---|---|---|
Age, year, (median ± IQR) | 31 (27–35) | 32 (28–35) | 0.81 1 |
BMI, kg/m2, (median ± IQR) | 26 (22–29) | 25 (22–27) | 0.78 1 |
Primiparous, n (%) | 66 (61) | 47 (61) | 0.99 2 |
Previous PTB, n (%) | 28 (26) | 21 (27) | 0.84 2 |
Pregnancy, n (%) | 0.70 3 | ||
Singleton | 96 (89) | 67 (87) | |
Duplex | 10 (8) | 10 (13) | |
Triplex | 1 (1) | 0 | |
Quadriplex | 1 (1) | 0 | |
In vitro fertilization, n (%) | 18 (17) | 11 (14) | 0.62 2 |
Cervical conisation, n (%) | 8 (7) | 8 (10) | 0.48 2 |
Cervical cerclage, n (%) | 12 (11) | 8 (10) | 0.88 2 |
Hypertensive disease, n (%) | 13 (12) | 6 (8) | 0.35 2 |
Diabetes, n (%) | 1 (1) | 7 (9) | 0.04 2 |
Main reason for PTB n (%) | 0.03 3 | ||
Preterm labor | 53 (49) | 50 (65) | |
pPROM | 33 (31) | 13 (17) | |
IUGR with signs of fetal asphyxia | 9 (8) | 5 (6) | |
Hypertensive disease | 3 (3) | 4 (5) | |
Maternal disease | 1 (1) | 0 | |
Choriodecidual bleeding, n (%) | 12 (11) | 11 (14) | 0.52 2 |
Clinical chorioamnionitis, n (%) | 35 (32) | 29 (36) | 0.46 2 |
Antenatal corticosteroids, n (%) | 0.002 3 | ||
None | 51 (48) | 22 (29) | |
1 dose | 22 (21) | 13 (17) | |
2 doses | 34 (32) | 42 (55) | |
Delivery mode, n (%) | 0.76 3 | ||
Vaginal delivery | 92 (85) | 66 (86) | |
Cesarean section | 16 (15) | 11 (14) |
Variable | 2009–2015 n = 119 | 2016–2019 n = 86 | p Value |
---|---|---|---|
GA, n (%) | 0.74 2 | ||
22 + 0–6 wks | 43 (36) | 33 (38) | |
23 + 0–6 wks | 76 (64) | 53 (62) | |
Gender, n (%) | 0.99 2 | ||
Female | 53 (45) | 39 (45) | |
Male | 66 (55) | 47 (55) | |
BW, g (median ± IQR) | 526 (459–590) | 517 (462–589) | 0.81 1 |
Apgar score < 7, n (%) | 100/119 (84) | 75/86 (87) | 0.11 2 |
Live births, n (%) | 81/119 (68) | 66/86 (77) | 0.12 2 |
Intrauterine fetal death, n (%) | 38/119 (32) | 20/86 (23) | 0.12 2 |
Neonatal death ≤ 28 days, n (%) | |||
Of all births | 50/119 (42) | 25/86 (29) | 0.01 2 |
Of live births | 50/81 (62) | 25/66 (38) | 0.01 2 |
1- and 2-year survival, n (%) | |||
Of all births | 25/119 (21) | 34/86 (39) | 0.004 2 |
Of live births | 25/81 (31) | 34/66 (51) | 0.01 2 |
Variable | 2009–2015 n = 43 (%) | 2016–2019 n = 33 (%) | p Value |
---|---|---|---|
Live births | 24/43 (56) | 21/33 (64) | 0.55 |
Intrauterine fetal death | 19/43 (44) | 12/33 (36) | 0.55 |
Neonatal death ≤ 28 days | |||
Of all births | 23/43 (53) | 16/33 (48) | 0.18 |
Of live births | 23/24 (96) | 16/21 (76) | 0.05 |
1- and 2-year survival | |||
Of all births | 1/43 (2) | 5/33 (15) | 0.04 |
Of live births | 1/24 (4) | 5/21 (24) | 0.05 |
Variable | 2009–2015 n = 76 (%) | 2016–2019 n = 53 (%) | p Value |
---|---|---|---|
Live births | 57/76 (75) | 45/53 (85) | 0.16 |
Intrauterine fetal death | 19/76 (25) | 8/53 (20) | 0.16 |
Neonatal death ≤ 28 days | |||
Of all births | 32/76 (42) | 12/53 (17) | 0.005 |
Of live births | 32/57 (56) | 12/45 (27) | 0.01 |
1- and 2-year survival | |||
Of all births | 24/76 (32) | 29/53 (55) | 0.01 |
Of live births | 24/57 (42) | 29/45 (64) | 0.03 |
Variable | 2009–2015 n = 25 (%) | 2016–2019 n = 34 (%) | p Value 2 Sided Exact |
---|---|---|---|
GA | 0.29 1 | ||
22 + 0–6 wks | 1 (4) | 5 (15) | |
23 + 0–6 wks | 24 (96) | 29 (85) | |
Gender | 0.83 2 | ||
Female | 11 (44) | 14 (41) | |
Male | 14 (56) | 20 (59) | |
Pregnancy | 0.65 2 | ||
Singleton | 19 (76) | 24 (71) | |
Twin | 6 (24) | 10 (29) | |
Antenatal steroids | 0.08 2 | ||
None | 5 (20) | 1 (3) | |
1 dose | 5 (20) | 8 (23) | |
2 doses | 15 (60) | 25 (74) | |
RDS | 24 (96) | 32 (94) | 0.75 1 |
BPD | 22 (88) | 28 (85) | 0.58 1 |
PPH | 4 (16) | 6 (18) | 0.87 1 |
IVH stage 1–4 | 10 (40) | 15 (45) | 0.82 1 |
IVH severe stage 3–4 | 3 (12) | 3 (9) | |
Neonatal seizures | 1 (4) | 1 (3) | 0.83 1 |
Sepsis or pneumonia | 18 (72) | 26 (76) | 0.70 1 |
NEC diagnosis | 7 (28) | 6 (18) | 0.64 2 |
Ileus | 1 (4) | 2 (6) | |
Bowel perforation | 0 | 1 (3) | |
Abdominal surgery | 5 (25) | 8 (24) | 0.56 1 |
ROP stage 1–5 | 17 (68) | 33 (97) | 0.02 1 |
ROP severe stage 4–5 | 8 (32) | 16 (47) | |
Persistent ductus arteriosus | 23 (92) | 29 (85) | 0.44 1 |
Hyperbilirubinemia | 20 (80) | 31 (91) | 0.22 1 |
Anemia | 22 (88) | 30 (88) | 0.98 1 |
Variable | 2009–2015 n = 25 | 2016–2019 n = 34 | p Value | 2009–2015 22 wks | 2016–2019 22 wks | 2009–2015 23 wks | 2016–2019 23 wks |
---|---|---|---|---|---|---|---|
GA, n (%) | 1 | 5 | 24 | 29 | |||
22 + 0–22 + 6 wks | 1 (4) | 5 (15) | |||||
23 + 0–23 + 6 wks | 24 (96) | 29 (85) | |||||
Bayley-III Scale, n (%) | 13/25 (52) | 28/34 (82) | 0.01 2 | 1 (100) | 5 (100) | 12 (50) | 23 (79) |
Cognition index score, mean (95% CI) | 86.9 (14.0–32.2) | 82.7 (14.2–24.7) | 0.33 1 | ||||
Cognition index score, n (%) | n = 13 | n = 28 | |||||
Moderate/severe disability (score ≤ 82) | 5 (38) | 12 (43) | 0 | 5 | 5 | 7 | |
No/mild disability (score ≥ 83) | 8 (62) | 16 (57) | 1 | 0 | 7 | 16 | |
Language index score, mean (95% CI) | 79.6 (13.3–32.3) | 75.0 (17.3–30.1) | 0.39 1 | ||||
Language index score, n (%) | n = 13 | n = 28 | |||||
Moderate/severe disability (score ≤ 84) | 8 (62) | 21 (75) | 0 | 3 | 8 | 18 | |
No/mild disability (score ≥ 85) | 5 (38) | 7 (25) | 1 | 2 | 4 | 5 |
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Christiansson, Y.; Moberg, M.; Rakow, A.; Stjernholm, Y.V. Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019. J. Clin. Med. 2023, 12, 4048. https://doi.org/10.3390/jcm12124048
Christiansson Y, Moberg M, Rakow A, Stjernholm YV. Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019. Journal of Clinical Medicine. 2023; 12(12):4048. https://doi.org/10.3390/jcm12124048
Chicago/Turabian StyleChristiansson, Yasemin, Maria Moberg, Alexander Rakow, and Ylva Vladic Stjernholm. 2023. "Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019" Journal of Clinical Medicine 12, no. 12: 4048. https://doi.org/10.3390/jcm12124048