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4. Wide variation in severe neonatal morbidity among very preterm infants in European regions

Author

Bonamy, Anna Karin Edstedt, Zeitlin, Jennifer, Piedvache, Aurelie, Maier, Rolf F., van Heijst, Arno, Varendi, Heili, Manktelow, Bradley N., Fenton, Alan, Mazela, Jan, Cuttini, Marina, Norman, Mikael, Petrou, Stavros, Van Reempts, Patrick, Barros, Henrique, Draper, Elizabeth S., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graca, L. M., Machado, M. C., Rodrigues, Carina, Rodrigues, T., Bonamy, A. K., Norman, M., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W. A., Zeitlin, J., Bonet, M., Piedvache, A., and Epice Res Grp

Subjects
macromolecular substances, Human medicine
Abstract

Objective To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. Design Area-based cohort study of all births before 32 weeks of gestational age. Setting 16 regions in 11 European countries in 2011/2012. Patients Survivors to discharge from neonatal care (n=6422). Main outcome measures Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades >= 3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. Results 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P< 0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P= 0.50). Conclusion Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.

Published
2019

5. Wide variation in severe neonatal morbidity among very preterm infants in european regions

Author

Edstedt Bonamy, A-K. (Anna-Karin), Zeitlin, J. (Jennifer), Piedvache, A. (Aurelie), Maier, R.F. (Rolf F.), Van Heijst, A. (Arno), Varendi, H. (Heili), Manktelow, B.N. (Bradley N.), Fenton, A. (Alan), Mazela, J. (Jan), Cuttini, M. (Marina), Norman, M. (Mikael), Petrou, S. (Stavros), Van Reempts, P. (Patrick), Barros, H. (Henrique), Draper, E.S. (Elizabeth S.), Martens, E. (E.), Martens, G. (G.), Boerch, K. (K.), Hasselager, A. (A.), Huusom, L. (L.), Pryds, O. (O.), Weber, T. (Tom), Toome, L. (Liis), Ancel, P-Y. (Pierre-Yves), Blondel, B. (Béatrice), Burguet, A. (Antoine), Jarreau, P-H. (Pierre-Henri), Truffert, P. (Patrick), Schmidt, S. (S.), Gortner, L. (Ludwig), Baronciani, D. (D.), Gargano, G. (G.), Agostino, R. (R.), Dilallo, D. (D.), Franco, F. (F.), Carnielli, V. (V.), Koopman-Esseboom, C. (C.), Nijman, J. (J.), Gadzinowski, J. (Janusz), Graca, L.M. (L. M.), Machado, M.C. (M. C.), Rodrigues, C. (Carina), Rodrigues, T. (T.), Wilson, E. (Emilija), Boyle, E.M. (Eileen Mary), Milligan, D.W.A. (D. W. A.), Bonet, M. (Mercedes), CHU Lille, Université de Lille, Karolinska Institutet [Stockholm], METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité [CRESS (U1153 / UMR_A_1125 / UMR_S_1153)], Radboud University Medical Center [Nijmegen], University of Tartu, University of Leicester, Newcastle University [Newcastle], IRCCS Ospedale Pediatrico Bambino Gesù [Roma], Poznan University of Medical Sciences [Poland] [PUMS], University of Warwick [Coventry], University of Antwerp [UA], Hvidovre Hospital, Université Paris Descartes - Paris 5 [UPD5], CHU Dijon, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS], Saarland University [Saarbrücken], Istituto Nazionale di Riposo e Cura per Anziani di Ancona, University Medical Center [Utrecht], Université de Lisbonne, Hospital de São João [Porto], Karolinska University Hospital [Stockholm], and Royal Victoria Hospital

Abstract

OBJECTIVE: To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. METHODS: Area-based cohort study of all births before 32 weeks of gestational age. METHODS: 16 regions in 11 European countries in 2011/2012. METHODS: Survivors to discharge from neonatal care (n=6422). METHODS: Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. RESULTS: 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%-23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P

Published
2019

6. Low breastfeeding continuation to 6 months for very preterm infants: A European multiregional cohort study

Author

MS Neonatologie, Arts-assistenten Kinderen, Bonnet, Camille, Blondel, Béatrice, Piedvache, Aurélie, Wilson, Emilija, Bonamy, Anna Karin Edstedt, Gortner, L., Rodrigues, Carina, van Heijst, Arno, Draper, Elizabeth S., Cuttini, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, T., Barros, H., Bonamy, A. K., Norman, M., Wilson, E., the EPICE Research Group, MS Neonatologie, Arts-assistenten Kinderen, Bonnet, Camille, Blondel, Béatrice, Piedvache, Aurélie, Wilson, Emilija, Bonamy, Anna Karin Edstedt, Gortner, L., Rodrigues, Carina, van Heijst, Arno, Draper, Elizabeth S., Cuttini, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, T., Barros, H., Bonamy, A. K., Norman, M., Wilson, E., and the EPICE Research Group

Published
2019

8. Use of magnesium sulfate before 32 weeks of gestation : A European population-based cohort study

Author

Wolf, H. T., Huusom, L., Weber, T., Piedvache, A., Schmidt, S., Norman, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Pryds, O., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Cuttini, M., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., MacHado, M. C., Rodrigues, C., Rodrigues, T., Barros, H., Bonamy, A. K., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, and Bonet, M.

Subjects
Severity of Illness Index, Cohort Studies, 0302 clinical medicine, PREVENTIVE MEDICINE, Pre-Eclampsia, Pregnancy, Obstetrics and Gynaecology, Eclampsia, 030212 general & internal medicine, Practice Patterns, Physicians', reproductive and urinary physiology, Medicine(all), education.field_of_study, 030219 obstetrics & reproductive medicine, Evidence-Based Medicine, Obstetrics, Medical record, General Medicine, Calcium Channel Blockers, female genital diseases and pregnancy complications, 3. Good health, Europe, Pregnancy Trimester, Second, embryonic structures, Population study, Gestation, Premature Birth, Female, Guideline Adherence, Cohort study, Adult, medicine.medical_specialty, HELLP Syndrome, Population, Gestational Age, 03 medical and health sciences, Magnesium Sulfate, Young Adult, Intensive care, medicine, Journal Article, Humans, education, Fetus, business.industry, Research, fungi, medicine.disease, equipment and supplies, business
Abstract

Objectives: The use of magnesium sulfate (MgSO4) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO4 in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO4 before delivery. 41% of units reported use of MgSO4 whenever possible for pre-eclampsia and administered MgSO4 more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO4. 9 units (7.6%) reported using MgSO4 for fetal neuroprotection whenever possible. In these units, the median rate of MgSO4 use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO4 as a first-line tocolytic. Among women without preeclampsia, MgSO4 use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO4 as frequently as evidence-based medicine recommends. MgSO4 is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO4 is needed.

Published
2017
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9. Evidence-based neonatal unit practices and determinants of Postnatal corticosteroid-use in preterm births below 30 weeks ga in Europe : A population-based cohort study

Author

Nuytten, Alexandra, Behal, Hélène, Duhamel, Alain, Jarreau, Pierre Henri, Mazela, Jan, Milligan, David, Gortner, Ludwig, Piedvache, Aurélie, Zeitlin, Jennifer, Truffert, Patrick, Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, T., Barros, H., Bonamy, A. K., Norman, M., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, Zeitlin, J., Bonet, M., Piedvache, A., Nuytten, Alexandra, Behal, Hélène, Duhamel, Alain, Jarreau, Pierre Henri, Mazela, Jan, Milligan, David, Gortner, Ludwig, Piedvache, Aurélie, Zeitlin, Jennifer, Truffert, Patrick, Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, T., Barros, H., Bonamy, A. K., Norman, M., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, Zeitlin, J., Bonet, M., and Piedvache, A.

Published
2017

10. Use of magnesium sulfate before 32 weeks of gestation: A European population-based cohort study

Author

MS Neonatologie, Brain, Arts-assistenten Kinderen, Wolf, H. T., Huusom, L., Weber, T., Piedvache, A., Schmidt, S., Norman, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Pryds, O., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Cuttini, M., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., MacHado, M. C., Rodrigues, C., Rodrigues, T., Barros, H., Bonamy, A. K., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, Bonet, M., MS Neonatologie, Brain, Arts-assistenten Kinderen, Wolf, H. T., Huusom, L., Weber, T., Piedvache, A., Schmidt, S., Norman, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Pryds, O., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Cuttini, M., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., MacHado, M. C., Rodrigues, C., Rodrigues, T., Barros, H., Bonamy, A. K., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, and Bonet, M.

Published
2017

11. Evidence-based neonatal unit practices and determinants of Postnatal corticosteroid-use in preterm births below 30 weeks ga in Europe: A population-based cohort study

Author

MS Neonatologie, Brain, Arts-assistenten Kinderen, Nuytten, Alexandra, Behal, Hélène, Duhamel, Alain, Jarreau, Pierre Henri, Mazela, Jan, Milligan, David, Gortner, Ludwig, Piedvache, Aurélie, Zeitlin, Jennifer, Truffert, Patrick, Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, T., Barros, H., Bonamy, A. K., Norman, M., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, Zeitlin, J., Bonet, M., Piedvache, A., MS Neonatologie, Brain, Arts-assistenten Kinderen, Nuytten, Alexandra, Behal, Hélène, Duhamel, Alain, Jarreau, Pierre Henri, Mazela, Jan, Milligan, David, Gortner, Ludwig, Piedvache, Aurélie, Zeitlin, Jennifer, Truffert, Patrick, Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Weber, T., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, T., Barros, H., Bonamy, A. K., Norman, M., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W A, Zeitlin, J., Bonet, M., and Piedvache, A.

Published
2017

12. Use of magnesium sulfate before 32 weeks of gestation:A European population-based cohort study

Author

Wolf, H. T., Weber, T., Piedvache, A., Schmidt, S., Norman, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Cuttini, M., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., MacHado, M. C., Rodrigues, C., Rodrigues, T., Barros, H., Bonamy, A. K., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., Fenton, A. C., Wolf, H. T., Weber, T., Piedvache, A., Schmidt, S., Norman, M., Zeitlin, J., Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L., Pryds, O., Toome, L., Varendi, H., Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Cuttini, M., Koopman-Esseboom, C., Van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., MacHado, M. C., Rodrigues, C., Rodrigues, T., Barros, H., Bonamy, A. K., Wilson, E., Boyle, E., Draper, E. S., Manktelow, B. N., and Fenton, A. C.

Abstract

Objectives: The use of magnesium sulfate (MgSO4) in European obstetric units is unknown. We aimed to describe reported policies and actual use of MgSO4 in women delivering before 32 weeks of gestation by indication. Methods: We used data from the European Perinatal Intensive Care in Europe (EPICE) population-based cohort study of births before 32 weeks of gestation in 19 regions in 11 European countries. Data were collected from April 2011 to September 2012 from medical records and questionnaires. The study population comprised 720 women with severe preeclampsia, eclampsia or HELLP and 3658 without preeclampsia delivering from 24 to 31 weeks of gestation in 119 maternity units with 20 or more very preterm deliveries per year. Results: Among women with severe pre-eclampsia, eclampsia or HELLP, 255 (35.4%) received MgSO4 before delivery. 41% of units reported use of MgSO4 whenever possible for pre-eclampsia and administered MgSO4 more often than units reporting use sometimes. In women without pre-eclampsia, 95 (2.6%) received MgSO4. 9 units (7.6%) reported using MgSO4 for fetal neuroprotection whenever possible. In these units, the median rate of MgSO4 use for deliveries without severe pre-eclampsia, eclampsia and HELLP was 14.3%. Only 1 unit reported using MgSO4 as a first-line tocolytic. Among women without preeclampsia, MgSO4 use was not higher in women hospitalised before delivery for preterm labour. Conclusions: Severe pre-eclampsia, eclampsia or HELLP are not treated with MgSO4 as frequently as evidence-based medicine recommends. MgSO4 is seldom used for fetal neuroprotection, and is no longer used for tocolysis. To continuously lower morbidity, greater attention to use of MgSO4 is needed.

Published
2017

13. Maternal tobacco use and extremely premature birth - a population-based cohort study

Author

Dahlin, S., Gunnerbeck, A., Wikström, Anna-Karin, Cnattingius, S., Bonamy, A-K Edstedt, Dahlin, S., Gunnerbeck, A., Wikström, Anna-Karin, Cnattingius, S., and Bonamy, A-K Edstedt

Abstract

Objective To study the associations of maternal tobacco use (smoking or use of snuff) and risk of extremely preterm birth, and if tobacco cessation before antenatal booking influences this risk. To study the association between tobacco use and spontaneous or medically indicated onset of delivery. Design Population-based cohort study. Setting Sweden. Population All live singleton births, registered in the Swedish Medical Birth Register, 1999-2012. Methods Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis. Main outcome measures Extremely preterm birth (<28 weeks of gestation), very preterm birth (28-31 weeks), moderately preterm birth (32-36 weeks). Results Maternal snuff use (OR 1.58; 95% CI: 1.14-2.21) and smoking (OR 1.61; 95% CI: 1.39-1.87 and OR 1.91; 95% CI: 1.53-2.39 for moderate and heavy smoking, respectively) were associated with an increased risk of extremely preterm birth. When cessation of tobacco use was obtained there was no increased risk of preterm birth. Snuff use was associated with a twofold risk increase of medically indicated extremely preterm birth, whereas smoking was associated with increased risks of both medically indicated and spontaneous extremely preterm birth. Conclusions Snuff use and smoking in pregnancy were associated with increased risks of extremely preterm birth. Women who stopped using tobacco before the antenatal booking had no increased risk. These findings indicate that nicotine, the common substance in cigarettes and snuff, is involved in the mechanisms behind preterm birth. The use of nicotine should be minimized in pregnancy.

Published
2016
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24. Strategies for assessing the impact of loss to follow-up on estimates of neurodevelopmental impairment in a very preterm cohort at 2 years of age

Author

Piedvache, Aurélie, van Buuren, Stef, Barros, Henrique, Ribeiro, Ana Isabel, Draper, Elizabeth, Zeitlin, Jennifer, Martens, E., Martens, G., Van Reempts, P., Boerch, K., Hasselager, A., Huusom, L. D., Pryds, O., Weber, T., Toome, L., Varendi, H., France, Ile-de, Ancel, P. Y., Blondel, B., Burguet, A., Jarreau, P. H., Truffert, P., Maier, R. F., Misselwitz, B., Schmidt, S., Gortner, L., Baronciani, D., Gargano, G., Agostino, R., DiLallo, D., Franco, F., Carnielli, V., Koopman-Esseboom, C., van Heijst, A., Nijman, J., Gadzinowski, J., Mazela, J., Graça, L. M., Machado, M. C., Rodrigues, Carina, Rodrigues, T., Bonamy, A. K., Norman, M., Boyle, E. Wilson E, Draper, E. S., Manktelow, B. N., Fenton, A. C., Milligan, D. W. A., Zeitlin, J., Bonet, M., and Piedvache, A.

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26. Maternal tobacco use and extremely premature birth - a population-based cohort study.

Author

Dahlin S, Gunnerbeck A, Wikström AK, Cnattingius S, and Edstedt Bonamy AK

Subjects
Cohort Studies, Female, Gestational Age, Humans, Infant, Newborn, Pregnancy, Prevalence, Risk Factors, Sweden epidemiology, Infant, Extremely Premature, Premature Birth epidemiology, Premature Birth etiology, Smoking adverse effects
Abstract

Objective: To study the associations of maternal tobacco use (smoking or use of snuff) and risk of extremely preterm birth, and if tobacco cessation before antenatal booking influences this risk. To study the association between tobacco use and spontaneous or medically indicated onset of delivery., Design: Population-based cohort study., Setting: Sweden., Population: All live singleton births, registered in the Swedish Medical Birth Register, 1999-2012., Methods: Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis., Main Outcome Measures: Extremely preterm birth (<28 weeks of gestation), very preterm birth (28-31 weeks), moderately preterm birth (32-36 weeks)., Results: Maternal snuff use (OR 1.58; 95% CI: 1.14-2.21) and smoking (OR 1.61; 95% CI: 1.39-1.87 and OR 1.91; 95% CI: 1.53-2.39 for moderate and heavy smoking, respectively) were associated with an increased risk of extremely preterm birth. When cessation of tobacco use was obtained there was no increased risk of preterm birth. Snuff use was associated with a twofold risk increase of medically indicated extremely preterm birth, whereas smoking was associated with increased risks of both medically indicated and spontaneous extremely preterm birth., Conclusions: Snuff use and smoking in pregnancy were associated with increased risks of extremely preterm birth. Women who stopped using tobacco before the antenatal booking had no increased risk. These findings indicate that nicotine, the common substance in cigarettes and snuff, is involved in the mechanisms behind preterm birth. The use of nicotine should be minimized in pregnancy., Tweetable Abstract: Tobacco use increases risk of extremely preterm birth. Cessation is preventive. Avoid nicotine in pregnancy., (© 2016 Royal College of Obstetricians and Gynaecologists.)

Published
2016
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27. [Patent ductus arteriosus. A common clinical problem in extremely premature infants].

Author

Edstedt-Bonamy AK, Johansson S, and Milerad J

Subjects
Cyclooxygenase Inhibitors administration & dosage, Fluid Therapy, Humans, Incidence, Indomethacin administration & dosage, Infant, Infant, Newborn, Intensive Care, Neonatal methods, Surgical Procedures, Operative methods, Sweden epidemiology, Ductus Arteriosus, Patent diagnosis, Ductus Arteriosus, Patent epidemiology, Ductus Arteriosus, Patent therapy, Infant, Premature, Diseases diagnosis, Infant, Premature, Diseases epidemiology, Infant, Premature, Diseases therapy
Abstract

An analysis was made of the incidence and treatment regimen of symptomatic patent ductus arteriosus (PDA) in 95 preterm infants treated 1997-1999 in a level three intensive care unit in Stockholm. 47 infants (49 percent) had PDA. Of these 17 infants were managed conservatively (fluid restriction and diuretics), 13 were treated with indomethacin, 10 underwent primary surgical ligation and 7 were treated with indomethacin first and surgery later on. The proportion of infants given "active" therapy (surgery and/or indomethacin) rose from 50 percent in 1997 to 85 percent in 1999. In a stepwise multiple regression analysis low birthweight, septicaemia and need for mechanical ventilation were all independently associated with PDA.

Published
2000

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