{"doi":"10.1136/bmjopen-2018-024560","title":"Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study","abstract":"<jats:sec>\n                    <jats:title>Objectives</jats:title>\n                    <jats:p>To investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22–25 and cohort B born at 26–27 gestational weeks, respectively.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Design</jats:title>\n                    <jats:p>Geographically defined, retrospective cohort study.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting</jats:title>\n                    <jats:p>All nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients</jats:title>\n                    <jats:p>All live-born infants in Switzerland in 2006–2013 below 28 gestational weeks, excluding infants with major congenital malformation.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures</jats:title>\n                    <jats:p>Outcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Cohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Centres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.</jats:p>\n                  </jats:sec>","journal":"BMJ Open","year":2019,"id":612478,"datarank":0.41588830833596724,"base_score":2.772588722239781,"endowment":2.772588722239781,"self_citation_contribution":0.41588830833596724,"citation_network_contribution":0.0,"self_endowment_contribution":0.41588830833596724,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1577007,"name":"Thomas M Berger","orcid":null,"position":1,"is_corresponding":false},{"id":1577008,"name":"Cristina Borradori-Tolsa","orcid":null,"position":2,"is_corresponding":false},{"id":1577009,"name":"Myriam Bickle-Graz","orcid":null,"position":3,"is_corresponding":false},{"id":1577010,"name":"Sebastian Grunt","orcid":null,"position":4,"is_corresponding":false},{"id":1577011,"name":"Roland Gerull","orcid":null,"position":5,"is_corresponding":false},{"id":1577012,"name":"Dirk Bassler","orcid":null,"position":6,"is_corresponding":false},{"id":1577013,"name":"Giancarlo Natalucci","orcid":null,"position":7,"is_corresponding":false},{"id":1362639,"name":"Mark Adams","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study","abstract":"<jats:sec>\n                    <jats:title>Objectives</jats:title>\n                    <jats:p>To investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22–25 and cohort B born at 26–27 gestational weeks, respectively.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Design</jats:title>\n                    <jats:p>Geographically defined, retrospective cohort study.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting</jats:title>\n                    <jats:p>All nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients</jats:title>\n                    <jats:p>All live-born infants in Switzerland in 2006–2013 below 28 gestational weeks, excluding infants with major congenital malformation.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures</jats:title>\n                    <jats:p>Outcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Cohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>Centres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":2.772588722239781,"endowment":2.772588722239781,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"30878980","pmcid":"PMC6429852","openalex_id":"https://openalex.org/W2921448621","authors":[],"funders":[{"funder_name":"Swiss National Science Foundation","grant_id":"161146","title":"Impact of intrauterine growth restriction on brain development and consequences for later neurodevelopmental outcome: a prospective cohort study"}],"total_grants":1,"fwci":3.531,"citation_percentile":0.91885426,"influential_citations":0,"citation_trend":[{"year":2020,"count":4},{"year":2021,"count":2},{"year":2022,"count":4},{"year":2024,"count":1},{"year":2025,"count":4}],"oa_status":"gold","license":"cc-by-nc","oa_locations":[{"url":"https://bmjopen.bmj.com/content/bmjopen/9/3/e024560.full.pdf","host_type":"journal"},{"url":"https://bmjopen.bmj.com/content/bmjopen/9/3/e024560.full.pdf","host_type":"publisher"},{"url":"https://syndication.highwire.org/content/doi/10.1136/bmjopen-2018-024560","host_type":"publisher"},{"url":"https://doi.org/10.1136/bmjopen-2018-024560","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/30878980","host_type":"repository"},{"url":"https://serval.unil.ch/notice/serval:BIB_B2365355C478","host_type":"repository"},{"url":"https://archive-ouverte.unige.ch/unige:136376","host_type":"repository"},{"url":"https://iris.unil.ch/handle/iris/202900","host_type":"repository"},{"url":"https://boris.unibe.ch/129892/","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/6429852","host_type":"repository"},{"url":"http://bmjopen.bmj.com/cgi/content/short/9/3/e024560","host_type":"repository"},{"url":"https://doi.org/10.5167/uzh-171016","host_type":""},{"url":"https://iris.unil.ch/bitstreams/5be3a99b-b235-4353-af0e-e3097fd578a6/download","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC6429852","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC6429852?pdf=render","host_type":"Europe_PMC"},{"url":"https://dx.doi.org/10.7892/boris.129892","host_type":""},{"url":"http://dx.doi.org/10.1136/bmjopen-2018-024560","host_type":""},{"url":"https://dx.doi.org/10.1136/bmjopen-2018-024560","host_type":""},{"url":"https://sonar.ch/global/documents/177964","host_type":""},{"url":"https://serval.unil.ch/resource/serval:BIB_B2365355C478.P001/REF.pdf","host_type":""},{"url":"http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_B2365355C4789","host_type":""}],"fields_of_study":["Infant Development and Preterm Care","Neonatal Respiratory Health Research","Maternal and Neonatal Healthcare","03 medical and health sciences","0302 clinical medicine","Child, Preschool","Developmental Disabilities","Female","Gestational Age","Humans","Infant","Infant Mortality","Infant, Extremely Premature","Infant, Newborn","Intensive Care Units, Neonatal","Length of Stay","Male","Perinatal Care","Retrospective Studies","Switzerland"],"mesh_terms":["Developmental Disabilities","Child, Preschool","Female","Gestational Age","Humans","Infant","Infant Mortality","Infant, Newborn","Intensive Care Units, Neonatal","Length of Stay","Male","Retrospective Studies","Switzerland","Perinatal Care","Infant, Extremely Premature"],"keywords":["Medicine","Cohort","Pediatrics","Gestational age","Cohort study","Retrospective cohort study","Intensive care","Population","Neonatal intensive care unit","Pregnancy","Obstetrics","Internal medicine","Intensive care medicine","Fetal Medicine","Neonatology","Quality In Health Care","Male","Developmental Disabilities","Child, Preschool; Developmental Disabilities/epidemiology; Female; Gestational Age; Humans; Infant; Infant Mortality; Infant, Extremely Premature; Infant, Newborn; Intensive Care Units, Neonatal/standards; Length of Stay/statistics & numerical data; Male; Perinatal Care/standards; Retrospective Studies; Switzerland/epidemiology; fetal medicine; neonatology; quality in health care","618","Intensive Care Units, Neonatal","Infant Mortality","Humans","Retrospective Studies","Infant, Newborn","Infant","Paediatrics","Length of Stay","Perinatal Care","Child, Preschool","Infant, Extremely Premature","Female","Switzerland"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. 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