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Birth outcomes between 22 and 26 weeks' gestation in national population‐based cohorts from Sweden, England and France
Author(s) -
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,
Foix L'Helias Laurence,
Ancel PierreYves,
Marlow Neil
Publication year - 2022
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.16084
Subject(s) - medicine , proportional hazards model , gestation , survival analysis , gestational age , population , overall survival , pregnancy , demography , survival rate , pediatrics , obstetrics , biology , genetics , environmental health , sociology
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 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.