BACKGROUND Perinatal decision-making affects outcomes for extremely preterm babies (22-26 weeks' gestational age (GA)): more active units have improved survival without increased morbidity. We hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. We examined mortality and morbidity outcomes at age two for babies born at 27-28 weeks' GA in relation to the intensity of perinatal care provided to extremely preterm babies. METHODS Fetuses from the 2011 French national prospective EPIPAGE-2 cohort, alive at maternal admission to a level 3 hospital and delivered at 27-28 weeks' GA, were included. Morbidity-free survival (survival without sensorimotor (blindness, deafness or cerebral palsy) disability) and overall survival at age two were examined. Sensorimotor disability and Ages and Stages Questionnaire (ASQ) result below threshold among survivors were secondary outcomes. Perinatal care intensity level was based on birth hospital, grouped using the ratio of 24-25 weeks' GA babies admitted to neonatal intensive care to fetuses of the same gestation alive at maternal admission. Sensitivity analyses used ratios based upon antenatal steroids, Caesarean section, and newborn resuscitation. Multiple imputation was used for missing data; hierarchical logistic regression accounted for births nested within centres. RESULTS 633 of 747 fetuses (84.7%) born at 27-28 weeks' GA survived to age two. There were no differences in survival or morbidity-free survival: respectively, fully adjusted odds ratios were 0.96 (95% CI: 0.54 to 1.71) and 1.09 (95% CI: 0.59 to 2.01) in medium and 1.12 (95% CI: 0.63 to 2.00) and 1.16 (95% CI: 0.62 to 2.16) in high compared to low-intensity hospitals. Among survivors, there were no differences in sensorimotor disability or ASQ below threshold. Sensitivity analyses were consistent with the main results. CONCLUSIONS No difference was seen in survival or morbidity-free survival at two years of age among fetuses alive at maternal hospital admission born at 27-28 weeks' GA, or in sensorimotor disability or presence of an ASQ below threshold among survivors. There is no evidence for an impact of intensity of perinatal care for extremely preterm babies on births at a higher gestational age.

中文翻译：

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EPIPAGE-2队列研究的证据显示，极早产儿的围产期护理强度和更高的胎龄结局。

背景技术围产期决策影响极早产婴儿（22-26周胎龄（GA））的结局：更多活跃的单位可提高生存率，而不会增加发病率。我们假设这样的单位可能会获得技能和专门知识，这意味着处于较高胎龄的婴儿比在其他地方出生的婴儿具有更好的结局。我们检查了在GA出生27-28周时出生的婴儿在2岁时的死亡率和发病率，与为极早产婴儿提供的围产期护理强度有关。方法纳入了2011年法国国家前瞻性EPIPAGE-2研究组的胎儿，这些患者在产妇入三级医院时就活着，并在GA 27-28周时分娩。无病生存期（无感觉运动的生存期（失明，检查了2岁时的耳聋或脑瘫）残障和总体生存率。存活者中感觉运动障碍和年龄和阶段问卷（ASQ）的结果低于阈值是次要结果。围产期护理强度水平是根据出生医院划分的，按接受新生儿重症监护的24-25周GA婴儿与产妇入院时相同妊娠胎儿的比例进行分组。敏感性分析基于产前类固醇，剖腹产和新生儿复苏使用的比率。多次插补被用于丢失数据。分层逻辑回归分析说明了嵌套在中心内的出生。结果：在GA年龄27-28周出生的747胎中有633胎（84.7％）存活至2岁。生存或无病生存率无差异：在中等情况下，完全调整的优势比为0.96（95％CI：0.54至1.71）和1.09（95％CI：0.59至2.01）和1.12（95％CI：0.63至2.00）和1.16（95％CI：0.62至2.16）与低强度医院相比 在幸存者中，感觉运动障碍或ASQ低于阈值没有差异。敏感性分析与主要结果一致。结论在GA出生27-28周时在母体医院住院的胎儿中，两岁时的存活率或无病生存率无差异，幸存者中无感觉运动障碍或ASQ低于阈值。没有证据表明极早产儿的围产期护理强度会影响较高胎龄儿的出生。与低强度医院相比，高（00）和1.16（95％CI：0.62至2.16）。在幸存者中，感觉运动障碍或ASQ低于阈值没有差异。敏感性分析与主要结果一致。结论在GA出生27-28周时在母体医院住院的胎儿中，两岁时的存活率或无病生存率无差异，幸存者中无感觉运动障碍或ASQ低于阈值。没有证据表明极早产儿的围产期护理强度会影响较高胎龄儿的出生。与低强度医院相比，高（00）和1.16（95％CI：0.62至2.16）。在幸存者中，感觉运动障碍或ASQ低于阈值没有差异。敏感性分析与主要结果一致。结论在GA出生27-28周时在母体医院住院的胎儿中，两岁时的存活率或无病生存率无差异，幸存者中无感觉运动障碍或ASQ低于阈值。没有证据表明极早产儿的围产期护理强度会影响较高胎龄儿的出生。结论在GA至27-28周出生的孕妇住院时，两岁时的存活率或无病生存率无差异，幸存者中无感觉运动障碍或ASQ低于阈值。没有证据表明极早产儿的围产期护理强度会影响较高胎龄儿的出生。结论在GA出生27-28周时在母体医院住院的胎儿中，两岁时的存活率或无病生存率无差异，幸存者中无感觉运动障碍或ASQ低于阈值。没有证据表明极早产儿的围产期护理强度会影响较高胎龄儿的出生。