Centralisation of extremely preterm births and decreased early postnatal mortality in Sweden, 2004-2007 versus 2014-2016

• Published in: Acta Paediatrica
• Main Authors: Gadsbøll, Christian, Björklund, Lars J, Norman, Mikael, Abrahamsson, Thomas, Domellöf, Magnus, Elfvin, Anders, Farooqi, Aijaz, Hellström-Westas, Lena, Håkansson, Stellan, Källén, Karin, Normann, Erik, Serenius, Fredrik, Sävman, Karin, Um-Bergström, Petra, Ådén, Ulrika, Ley, David
• Format: Journal Article
• Language: English
• Published: Norway 23.09.2024
• Subjects: intraventricular haemorrhage; outborn; extremely preterm; centralisation of births; infant mortality
• ISSN: 0803-5253; 1651-2227; 1651-2227
• DOI: 10.1111/apa.17429

We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity. Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004-2007 and 2014-2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes. Among 1626 liveborn infants, 703 were born in 2004-2007 and 923 in 2014-2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31-3.07, p = 0.001). The higher 1-year mortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3-4 than inborn infants (22% vs. 14% in 2004-2007, and 22% vs. 13% in 2014-2016, both p < 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%-40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88). Centralisation of EPT births contributed to a lower 1-year mortality in 2014-2016 than that in 2004-2007, attributed to a decrease in deaths before 24 h among inborn infants.