• Mikael Norman, Boubou Hallberg, Thomas Abrahamsson, Lars J Björklund, Magnus Domellöf, Aijaz Farooqi, Cathrine Foyn Bruun, Christian Gadsbøll, Lena Hellström-Westas, Fredrik Ingemansson, Karin Källén, David Ley, Karel Maršál, Erik Normann, Fredrik Serenius, Olof Stephansson, Lennart Stigson, Petra Um-Bergström, and Stellan Håkansson.
• Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
• JAMA. 2019 Mar 26; 321 (12): 118811991188-1199.

ImportanceSince 2004-2007, national guidelines and recommendations have been developed for the management of extremely preterm births in Sweden. If and how more uniform management has affected infant survival is unknown.ObjectiveTo compare survival of extremely preterm infants born during 2004-2007 with survival of infants born during 2014-2016.Design, Setting And ParticipantsAll births at 22-26 weeks' gestational age (n = 2205) between April 1, 2004, and March 31, 2007, and between January 1, 2014, and December 31, 2016, in Sweden were studied. Prospective data collection was used during 2004-2007. Data were obtained from the Swedish pregnancy, medical birth, and neonatal quality registries during 2014-2016.ExposuresDelivery at 22-26 weeks' gestational age.Main Outcomes And MeasuresThe primary outcome was infant survival to the age of 1 year. The secondary outcome was 1-year survival among live-born infants who did not have any major neonatal morbidity (specifically, without intraventricular hemorrhage grade 3-4, cystic periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity stage 3-5, or severe bronchopulmonary dysplasia).ResultsDuring 2004-2007, 1009 births (3.3/1000 of all births) occurred at 22-26 weeks' gestational age compared with 1196 births (3.4/1000 of all births) during 2014-2016 (P = .61). One-year survival among live-born infants at 22-26 weeks' gestational age was significantly lower during 2004-2007 (497 of 705 infants [70%]) than during 2014-2016 (711 of 923 infants [77%]) (difference, -7% [95% CI, -11% to -2.2%], P = .003). One-year survival among live-born infants at 22-26 weeks' gestational age and without any major neonatal morbidity was significantly lower during 2004-2007 (226 of 705 infants [32%]) than during 2014-2016 (355 of 923 infants [38%]) (difference, -6% [95% CI, -11% to -1.7%], P = .008).Conclusions And RelevanceAmong live births at 22-26 weeks' gestational age in Sweden, 1-year survival improved between 2004-2007 and 2014-2016.

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