Neonatal Morbidity and 1-Year Survival of Extremely Preterm Infants Interview with:
Dr. Hans Jorgen Stensvold, M.D and
Dr. Arild Ronnestad, MD PhD
Neonatal Department, Oslo University Hospital and
the Norwegian Neonatal Network, Oslo, Norway What is the background for this study?

Response:  Over the last decades, advances in perinatal care have led to improved survival of extremely preterm infants in most countries. Still, the decision to initiate or withhold active care for infants at the border of viability is challenging. Different attitudes and traditions in perinatal care influence the rates of stillbirths, admissions to intensive care and outcomes. Consequently, there is a continuous need for up-to-date results to guide caregivers and parents in decision making, and to evaluate current medical practices. What are the main findings?

Response:  The Norwegian Extreme Prematurity Study (NEPS2) reports the 1-year survival and the neonatal morbidities of all pregnancies ending in stillbirth or live birth at 22 to 26 weeks gestation in Norway during 2013 and 2014.

After being alive on admission to an obstetrical unit, more babies were stillborn at 22 and 23 weeks compared to later. Ninety one per cent of all live-born infants were admitted to intensive care. One year-survival was 67% among live-born infants whereas 74% among infants admitted to a neonatal intensive care unit. Decreasing GA was strongly associated with mortality and moderately associated with neonatal morbidity. What should readers take away from your report?

Response: Contrasting recent reports from other European countries, our study showed no improvement in survival or neonatal morbidities over 15 years in Norway. Overall, only a modest change in the attitude towards active intervention was observed between 1999-2000 and 2013-2014. Very few infants born at 22 weeks were offered active care, and caesarean section performed on fetal indication was rare prior to 25 weeks.

Still, the survival rate in Norway among live born infants was significantly higher compared to recent population based studies from England and France. However, survival at 23 weeks was less likely in Norway compared to what reported by the Express study in Sweden. In a recent study from 11 neonatal centers in the United States, the survival among live-born infants of 22 to 24 weeks were 36% in 2008-2011, compared to 41% our most recent cohort. What recommendations do you have for future research as a result of this study?

Response:  The goal of future research is to identify ways to improve survival and limit neurodevelopmental impairment among surviving infants. With high quality datasets from population based neonatal registries, there is a lot to learn about strengths and limitations of the perinatal and neonatal care within centers, regions and countries. As Gagliardi and Ballù write in the editorial following our study: “Comparing neonatal outcomes across countries represents a great opportunity for quality improvement. To this aim, neonatal networks are well established worldwide, and there is need for sharing a minimum data set and methodology that could ease feasible and meaningful comparisons.”

Furthermore, given the lack of good prognostic tools prior to birth and uncertainties in the determination of gestational age, there is a need for more studies investigating early predictors of adverse outcomes, to guide caregivers and parents in making decision in these difficult situations. Thank you for your contribution to the community.


Pediatrics February 2017

Neonatal Morbidity and 1-Year Survival of Extremely Preterm Infants
Hans Jorgen Stensvold, Claus Klingenberg, Ragnhild Stoen, Dag Moster, Kristin Braekke, Hans Jorgen Guthe, Henriette Astrup, Siren Rettedal, Morten Gronn, Arild E. Ronnestad, on behalf of the Norwegian Neonatal Network

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 3, 2017 by Marie Benz MD FAAD