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      Low mortality and short‐term morbidity in very preterm infants in Austria 2011–2016

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          Abstract

          Aim

          The current study determined survival, short‐term neonatal morbidity and predictors for death or adverse outcome of very preterm infants in Austria.

          Methods

          This population‐based cohort study included 5197 very preterm infants (53.3% boys) born between 2011 and 2016 recruited from the Austrian Preterm Outcome Registry. Main outcome measures were gestational age‐related mortality and major short‐term morbidities.

          Results

          Overall, survival rate of all live‐born infants included was 91.6% and ranged from 47.1% and 73.4% among those born at 23 and 24 weeks of gestation to 84.9% and 88.2% among infants born at 25 and 26 weeks to more than 90.0% among those with a gestational age of 27 weeks or more. The overall prevalence of chronic lung disease, necrotising enterocolitis requiring surgery, intraventricular haemorrhage Grades 3–4, and retinopathy of prematurity Grades 3–5 was 10.0%, 2.1%, 5.5%, and 3.6%, respectively. Low gestational age, low birth weight, missing or incomplete course of antenatal steroids, male sex, and multiple births were significant risk predictors for death or adverse short‐term outcome.

          Conclusion

          In this national cohort study, overall survival rates were high and short‐term morbidity rate was low.

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          Most cited references19

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          Intensive care for extreme prematurity--moving beyond gestational age.

          Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients. We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months. Among study infants, 3702 (83%) received intensive care in the form of mechanical ventilation. Among the 4192 study infants (94%) for whom outcomes were determined at 18 to 22 months, 49% died, 61% died or had profound impairment, and 73% died or had impairment. In multivariable analyses of infants who received intensive care, exposure to antenatal corticosteroids, female sex, singleton birth, and higher birth weight (per each 100-g increment) were each associated with reductions in the risk of death and the risk of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age. At the same estimated likelihood of a favorable outcome, girls were less likely than boys to receive intensive care. The outcomes for infants who underwent ventilation were better predicted with the use of the above factors than with use of gestational age alone. The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. (ClinicalTrials.gov numbers, NCT00063063 [ClinicalTrials.gov] and NCT00009633 [ClinicalTrials.gov].). Copyright 2008 Massachusetts Medical Society.
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            Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study.

            The increasing survival rates of children who are born very preterm raise issues about the risks of neurological disabilities and cognitive dysfunction. We aimed to investigate neurodevelopmental outcome and use of special health care at 5 years of age in a population-based cohort of very preterm children. We included all 2901 livebirths between 22 and 32 completed weeks of gestation from nine regions in France in Jan 1-Dec 31, 1997, and a reference group of 667 children from the same regions born at 39-40 weeks of gestation. At 5 years of age, children had a medical examination and a cognitive assessment with the Kaufman assessment battery for children (K-ABC), with scores on the mental processing composite (MPC) scale recorded. Data for health-care use were collected from parents. Severe disability was defined as non-ambulatory cerebral palsy, MPC score less than 55, or severe visual or hearing deficiency; moderate deficiency as cerebral palsy walking with aid or MPC score of 55-69; and minor disability as cerebral palsy walking without aid, MPC score of 70-84, or visual deficit (<3/10 for one eye). In total, 1817 (77%) of the 2357 surviving children born very preterm had a medical assessment at 5 years and 396 (60%) of 664 in the reference group. Cerebral palsy was diagnosed in 159 (9%) of children born very preterm. Scores for MPC were available for 1534 children born very preterm: 503 (32%) had an MPC score less than 85 and 182 (12%) had an MPC score less than 70. Of the 320 children in the reference group, the corresponding values were 37 (12%) and 11 (3%), respectively. In the very preterm group, 83 (5%) had severe disability, 155 (9%) moderate disability, and 398 (25%) minor disability. Disability was highest in children born at 24-28 completed weeks of gestation (195 children [49%]), but the absolute number of children with disabilities was higher for children born at 29-32 weeks (441 children [36%]). Special health-care resources were used by 188 (42%) of children born at 24-28 weeks and 424 (31%) born at 29-32 weeks, compared with only 63 (16%) of those born at 39-40 weeks. In children who are born very preterm, cognitive and neuromotor impairments at 5 years of age increase with decreasing gestational age. Many of these children need a high level of specialised care. Prevention of the learning disabilities associated with cognitive deficiencies in this group is an important goal for modern perinatal care for children who are born very preterm and for their families.
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              An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity.

              (1984)
              Because of modern life-support systems capable of keeping tiny premature infants alive, retinopathy of prematurity has recurred. No classification system currently available adequately describes the observations of the disease being made today. A new classification system, the work of 23 ophthalmologists from 11 countries, is presented in an attempt to meet this need. It emphasizes the location and the extent of the disease in the retina as well as its stages. The term "plus" is employed with the stage to denote progressive vascular incompetence. A computer-compatible diagram for recording the results of the examination employing the new classification system is furnished.
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                Author and article information

                Contributors
                ursula.kohlendorfer@i-med.ac.at
                Journal
                Acta Paediatr
                Acta Paediatr
                10.1111/(ISSN)1651-2227
                APA
                Acta Paediatrica (Oslo, Norway : 1992)
                John Wiley and Sons Inc. (Hoboken )
                0803-5253
                1651-2227
                25 March 2019
                August 2019
                : 108
                : 8 ( doiID: 10.1111/apa.2019.108.issue-8 )
                : 1419-1426
                Affiliations
                [ 1 ] Department of Paediatrics II (Neonatology) Medical University of Innsbruck Innsbruck Austria
                [ 2 ] Department of Paediatrics Academic Teaching Hospital Landeskrankenhaus Feldkirch Feldkirch Austria
                [ 3 ] Department of Paediatrics Division of Neonatology Medical University of Graz Graz Austria
                [ 4 ] Division of Neonatology Paracelsus Medical University Salzburg Salzburg Austria
                [ 5 ] Department of Paediatrics Klinikum Wels‐Grieskirchen Wels Austria
                [ 6 ] Department of Paediatrics Kepler University Hospital Linz Austria
                [ 7 ] Department of Paediatrics Landesklinikum Wiener Neustadt Wiener Neustadt Austria
                [ 8 ] Department of Paediatrics and Adolescent Medicine Division of Neonatology Paediatric Intensive Care and Neuropaediatrics Medical University of Vienna Vienna Austria
                Author notes
                [*] [* ] Correspondence

                U Kiechl‐Kohlendorfer, MD, MSc, Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.

                Tel: +0043 512 504 27307 ¦

                Fax: +0043 512 27308 ¦

                Email: ursula.kohlendorfer@ 123456i-med.ac.at

                Author information
                https://orcid.org/0000-0003-0433-6196
                Article
                APA14767
                10.1111/apa.14767
                6767187
                30817025
                ec1bea59-e7d0-467b-9b36-99e1f8a2d560
                ©2019 The Authors. Acta Pædiatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Pædiatrica

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 09 November 2018
                : 24 January 2019
                : 26 February 2019
                Page count
                Figures: 1, Tables: 3, Pages: 8, Words: 6138
                Funding
                Funded by: Main Association of the Austrian Social Insurance Carriers
                Categories
                Regular Article
                Regular Articles
                Neonatology
                Custom metadata
                2.0
                apa14767
                August 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:30.09.2019

                Pediatrics
                preterm infants,short‐term outcome,survival
                Pediatrics
                preterm infants, short‐term outcome, survival

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