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Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation

Abstract

Objective

To examine outcomes at two institutions with different approaches to care among infants born at 22 weeks of gestation.

Study design

Retrospective, cohort study (2006–2015). Enrollment was limited to mother–infant dyads at 22 weeks of gestation. Proactive care was defined as provision of antenatal corticosteroids and neonatal resuscitation and intensive care. One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.

Result

Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01). Among the subgroup of infants receiving proactive care (UUCH: 40/40, 100%; NCH: 16/72, 22%) survival was higher at UUCH than at NCH (21/40, 53% vs. 3/16, 19%; P < 0.05).

Conclusion

Even when mother–infant dyads were provided proactive care at NCH (selective center), survival was lower than infants provided proactive care at UUCH (comprehensive center). Differences between the approaches to care at the two centers at 22 weeks of gestation merits further investigation.

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Acknowledgements

The authors would like to acknowledge Drs. Charles V Smith (Seattle Children’s Research Institute, University of Washington School of Medicine, Seattle, WA, USA) and Edward Bell (Department of Pediatrics, University of Iowa, Iowa City, IA, USA) for their contributions to the manuscript.

Author contributions

CHB, FS, JA, and BKR were involved in the acquisition of data and analysis and interpretation of data conception and design of manuscript, drafting the article, and revising it critically for important intellectual content; final approval of the version to be published, and provided agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RS and CWB were involved in the interpretation of data analysis, drafting the article, and revising it critically for important intellectual content; final approval of the version to be published, and provided agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CCM, HAF, and EGS were involved in the analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; final approval of the version to be published, and provided agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LDN and EN were involved in substantial contributions to conceptualization and design of the study; drafting the article and revising it critically for important intellectual content; final approval of the version to be published, and provided agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Carl H. Backes.

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Backes, C.H., Söderström, F., Ågren, J. et al. Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation. J Perinatol 39, 39–47 (2019). https://doi.org/10.1038/s41372-018-0248-y

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