{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:58:15Z","timestamp":1755799095676,"version":"3.40.3"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T00:00:00Z","timestamp":1684713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Perinatal management of extremely preterm births in Sweden has changed toward active care from 22\u201323 gestational weeks during the last decades. However, considerable regional differences exist. This study evaluates how one of the largest perinatal university centers has adapted to a more active care between 2004\u20132007 and 2012\u20132016 and if this has influenced infant survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>In this historical cohort study, women admitted with at least one live fetus and delivered at 22\u201325 gestational weeks (stillbirths included) at Karolinska University Hospital Solna during April 1, 2004\u2013March 31, 2007, and January 1, 2012\u2013December 31, 2016, were compared regarding rates of obstetric and neonatal interventions, and infant mortality and morbidity. Maternal, pregnancy and infant data from 2004\u20132007 were obtained from the Extreme Preterm Infants in Sweden Study while data from 2012\u20132016 were extracted from medical journals and quality registers. The same definitions of interventions and diagnoses were used for both study periods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 106 women with 118 infants during 2004\u20132007 and 213 women with 240 infants during 2012\u20132016 were included. Increases between the study periods were seen regarding cesarean delivery (overall rate 14% [17\/118] during 2004\u20132007 vs. 45% [109\/240] during 2012\u20132016), attendance of a neonatologist at birth (62% [73\/118] vs. 85% [205\/240]) and surfactant treatment at birth in liveborn infants (60% [45\/75] vs. 74% [157\/211]). Antepartum stillbirth rate decreased (13% [15\/118] vs. 5% [12\/240]) and the proportion of live births increased (80% [94\/118] vs. 88% [211\/240]) while 1\u2010year survival (64% [60\/94] vs. 67% [142\/211]) and 1\u2010year survival without major neonatal morbidity (21% [20\/94] vs. 21% [44\/211]) among liveborn infants did not change between the study periods. At 22 gestational weeks, interventions rates were still low during 2012\u20132016, most obvious regarding antenatal steroid treatment (23%), attendance of a neonatologist (51%), and intubation at birth (24%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Both obstetric and neonatal interventions at births below 26 gestational weeks increased between 2004\u20132007 and 2012\u20132016 in this single center study; however, at 22 gestational weeks they were still at a low level during 2012\u20132016. Despite more infants being born alive, 1\u2010year survival did not increase between the study periods.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14576","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T12:27:52Z","timestamp":1684758472000},"page":"716-727","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Changes in perinatal management and outcomes of extremely preterm infants born below 26\u2009weeks of gestation in a tertiary referral hospital in Sweden: Comparison between 2004\u20132007 and 2012\u20132016"],"prefix":"10.1111","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6735-743X","authenticated-orcid":false,"given":"Emma","family":"Aronsson","sequence":"first","affiliation":[{"name":"Pregnancy Care and Delivery Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2640-0753","authenticated-orcid":false,"given":"Malin","family":"Holzmann","sequence":"additional","affiliation":[{"name":"Pregnancy Care and Delivery Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2454-6847","authenticated-orcid":false,"given":"Marco","family":"Bartocci","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Neonatology Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6801-9398","authenticated-orcid":false,"given":"Ingela","family":"Hulth\u00e9n\u00a0Varli","sequence":"additional","affiliation":[{"name":"Pregnancy Care and Delivery Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1615-2829","authenticated-orcid":false,"given":"Sissel","family":"Saltvedt","sequence":"additional","affiliation":[{"name":"Pregnancy Care and Delivery Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.23580"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.2021"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.2052"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190940"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2017-000211"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2014.3351"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.771"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39555.670718.BE"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-1482"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1997.tb08921.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.12421"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-2988"},{"key":"e_1_2_11_14_1","unstructured":"V\u00e5rd av extremt f\u00f6r tidigt f\u00f6dda barn [Care of extremely premature children].In Danish. In: Socialstyrelsen editor. En v\u00e4gledning f\u00f6r v\u00e5rd av barn f\u00f6dda f\u00f6re 28 fullg\u00e5ngna graviditetsveckor.www.socialstyrelsen.se: Socialstyrelsen;2014. p.70."},{"key":"e_1_2_11_15_1","unstructured":"Domell\u00f6fMP.K. Riktlinjer vid hotande f\u00f6rtidsb\u00f6rd ska ge b\u00e4ttre och mer j\u00e4mlik v\u00e5rd\u2014Konsensusdokument f\u00f6r enhetligt omh\u00e4ndertagande av gravida och extremt f\u00f6r tidigt f\u00f6dda barn [Guidelines for threatening preterm birth should give better and more equal care\u2014Consensus document for unified management of pregnant and extremely premature babies.]. 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