784 - Preterm birth in the Nordic countries – capacity, management and outcome in neonatal care.

Large and unexplained regional variations in very preterm birth rates and mortality among very preterm infants have been reported in Europe, suggesting inequity in the quality of perinatal and neonatal care or differential exposure to risk factors.

Objective: To compare aspects of the health care system, perinatal management and short-term outcomes for very preterm infants in Nordic health care regions.

Design/Methods:

Population-based cohort study with information on preterm, liveborn infants in the 21 greater health care regions of Denmark, Finland, Iceland, Norway and Sweden gathered from national registers in 2021. Numbers of neonatal beds were reported by neonatal units. Preterm birth rates, case-mix, perinatal interventions, neonatal morbidity and survival to hospital discharge in very preterm infants (< 32 weeks of gestational age) were compared.

Results:

Out of 287,642 infants born alive, 16,567 (5.8%) were born preterm, varying from 5.2% in eastern Sweden and mid Norway, to 7.3% in northern Denmark (p< 0.05). In 2389 very preterm infants (0.83% of all live births, regional variation from 0.63% in eastern Finland to 1.2% in northern Denmark), exposure to antenatal corticosteroids varied from 85% to 98% between the Nordic regions, livebirths occurring at regional centers from 48% to 100%, surfactant treatment from 28% to 69%, and use of mechanical ventilation varied from 13% to 77% (p< 0.05 for all comparisons). Significant regional variations were also seen in capacity in neonatal care (neonatal beds varying from 2.6 in eastern Sweden to 7.3 per 1000 live births in eastern Finland), case-mix (rates of twins/triplets varied from 13% to 36%, and rates of infants with Apgar scores 0-3 at 5 min varied from 0 to 12%), and number of very low birthweight admissions, whereas there were no statistically significant differences in survival or major neonatal morbidities. Among all very preterm infants admitted for neonatal care in the Nordic countries (including those with malformations), infant survival was 66 (95% confidence interval: 59-71)% at 22-24 weeks, 92 (89-94)% at 25-27, and 98 (97-99)% at 28-31 weeks of gestational age.

Conclusion(s): Perinatal and neonatal management of very preterm infants exhibit significant regional variations in the Nordic countries, without a clear association to outcome.