MedicalResearch.com Interview with:
Mikael Norman, MD, PhD, Professor
Karolinska Institutet & Karolinska University Hospital
MedicalResearch.com: What is the background for this study?
Response: So far, preterm birth has been difficult to predict and prevent. In particular, extremely preterm birth has continued to be an issue in terms of optimal care before and after birth, costs and long term health outcomes. Therefore, studies on how the management and outcome varies over time in these patients are important.
MedicalResearch.com: What are the main findings?
Response: The study analysed survival among all Swedish babies (including those with malformations) born over 3.5 months preterm in week 22-26 and compared the statistics from 2014-2016 to those from 2004-2007. All Swedish hospitals participated in the study, which included 2,205 women who had complications during pregnancy leading to extremely preterm births.
Between these two time periods, the stillbirth rate dropped from 30 to 23 per cent, while the survival rate rose from 70 to 77 per cent. Further, the higher survival was not achieved at the cost of more complications during the neonate period; on the contrary, the researchers observed a reduction in the number of brain and lung damages in the babies born between 2014 and 2016, while the number of other problems, such as eye and abdominal complications, remained unchanged.
– Even if there are individual hospitals around the world that have been able to show similar results for selected patients, the survival of an entire population and for a whole country is top class,” says Mikael Norman, professor of Pediatrics at Karolinska Institutet in Stockholm, Sweden and the researcher responsible for the study.
The Swedish study found the greatest improvement in survival in babies born in week 22 (from week 22+0 days to week 22+6 days) with birth weights of between 290 and 730 grams. Fifty-eight per cent of those from this group who were admitted to neonatal intensive care between the years 2014 and 2016 survived to at least one year-of-age. As shown by the study results, this finding was associated with active care at birth (as opposed to compassionate, palliative care) of these infants, adopted in all centers at the end of the study period.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: The results suggest that central care support initiatives are effective. In recent years, amendments to laws, guidelines and national recommendations have strengthened healthcare provision and the status of extremely preterm babies. Ultimately though, says Professor Norman, the results of the study are testimony to the capabilities of all the midwives, nurses and doctors who provide pregnant women and their babies the best available care 24 hours a day.
“The profession and the authorities are both good at taking on board new knowledge and translating it into practice,” he says.
Long-standing national collaboration between researchers and clinicians, and the establishment of the national neonatal quality register are other important contributors.
“It has been essential to make available knowledge on how neonatal care has developed in Sweden,” says Professor Norman.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Problems related to long-term complications amongst extremely preterm babies remain as vital areas for research and quality improvement.
“Infections, malnutrition, skin damages and adverse events during neonatal intensive care are some areas that can and must be improved, at least in a Swedish context.”
Disclosures: The study was mainly financed by the Childhood Foundation of the Swedish Order of Freemasons in Stockholm. Mikael Norman has received research grants from the Heart and Lung Foundation in Sweden, and the EU through Horizon 2020. He has also received personal fees from the Swedish Medical Journal, the Swedish Patient Insurance company, Liber AB, Studentlitteratur AB and AbbVie AB.
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Norman M, Hallberg B, Abrahamsson T, 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(12):1188–1199. doi:10.1001/jama.2019.2021
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