Clinical Edge

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Swedish Strategies Improve Survival for Premature Infants

Key clinical point: The 1-year overall survival and survival without major morbidity among preterm infants in Sweden improved significantly after the adoption of specific treatment guidelines.

Major finding: The 1-year survival for live-born infants increased from 70% from 2004-2007 to 77% during 2014-2016.

Study details: The data come from a study of 1,009 and 1,196 extremely preterm births in Sweden during 2004-2007 and 2014-2016.

Disclosures: Dr. Norman reported receiving grants from the Swedish Heart Lung Foundation and the H2020/European Union, as well as personal fees from a Swedish medical journal, the Swedish patient insurance, Liber, Studentlitteratur, and AbbVie. The study was funded by the Swedish Order of Freemasons’ Foundation for Children’s Welfare.


Norman M et al. JAMA. 2019;321:1188-99.


The wide variation in outcomes for preterm birth worldwide raise questions as to whether the success seen in Sweden is possible in other countries, Matthew A. Rysavy, MD, PhD, and Danielle E. Y. Ehret, MD, MPH, wrote in an accompanying editorial. Considerations include population demographics, current guidelines, gestational age at which intensive care is offered, and the nature of follow-up care.

Sweden already has low rates of perinatal mortality, and current guidelines call for use of antenatal corticosteroids for births at 22 weeks’ gestation. By contrast, in the United States, antenatal corticosteroids are not recommended until 23-24 weeks’ gestation, they noted.

The editorialists called particular attention to the improvements in survival at 1 year and survival without major morbidity at 22-23 weeks’ gestation. “At 22 weeks’ gestation, the stillbirth rate decreased from 65% of all births during 2004-2007 to 35% during 2014-2016, with a reciprocal increase in live births.”

Although the results are promising, and show the possibilities for improving survival, the editorialists wrote that ongoing follow up of children born prematurely is essential to inform future research, as “much remains unknown about the later-life effects of being born so early and of the therapies used to sustain life after birth.”

Dr. Rysavy is affiliated with the department of pediatrics at the University of Iowa, Iowa City; Dr. Ehret is affiliated with the department of pediatrics at the University of Vermont, Burlington. This is a summary of their editorial accompanying the article by Norman et al. (JAMA. 2019 Mar 26;321:1163-64). They reported no financial conflicts.