Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population‐based studies in ten European regions

Bonet, Mercedes; Cuttini, Marina; Piedvache, Aurélie; Boyle, Elaine M.; Jarreau, Pierre‐Henri; Kollée, L.A.A.; Maier, Rolf F.; Milligan, David; Reempts, Patrick Van; Weber, Tom; Barros, Henrique; Gadzinowki, J; Draper, Elizabeth S; Zeitlin, Jennifer

doi:10.1111/1471-0528.14639

Cited by 22 publications

(20 citation statements)

References 39 publications

(58 reference statements)

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“…A study comparing five different European regions showed the largest differences in survival for babies born at 500 g or more at 24 weeks gestation; results for births at 23 and 25 weeks and below 500 g were much more similar [ 41 ]. More importantly, perhaps, there have been changes over time in attitudes to extremely preterm birth across Europe, and hospitals that have actively changed their policies seem to have experienced larger survival gains [ 42 ]. We also note that our findings are consistent with those from studies in Sweden [ 14 ] and the USA [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Morgan

L’Hélias

Diguisto

et al. 2018

BMC Med

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BackgroundEmerging evidence suggests intensity of perinatal care influences survival for extremely preterm babies. We evaluated the effect of differences in perinatal care intensity between centres on sensorimotor morbidity at 2 years of age. We hypothesised that hospitals with a higher intensity of perinatal care would have improved survival without increased disability.MethodsFoetuses alive at maternal admission to a level 3 hospital in France in 2011, subsequently delivered between 22 and 26 weeks gestational age (GA) and included in the EPIPAGE-2 national prospective observational cohort study formed the baseline population. Level of intensity of perinatal care was assigned according to hospital of birth, categorised into three groups using ‘perinatal intensity’ ratios (ratio of 24–25 weeks GA babies admitted to neonatal intensive care to foetuses of the same GA alive at maternal admission to hospital). Multiple imputation was used to account for missing data; hierarchical logistic regression accounting for births nested within centres was then performed.ResultsOne thousand one hundred twelve foetuses were included; 473 survived to 2 years of age (126 of 358 in low-intensity, 140 of 380 in medium-intensity and 207 of 374 in high-intensity hospitals). There were no differences in disability (adjusted odds ratios 0.93 (95% CI 0.28 to 3.04) and 1.04 (95% CI 0.34 to 3.14) in medium- and high- compared to low-intensity hospitals, respectively). Compared to low-intensity hospitals, survival without sensorimotor disability was increased in the population of foetuses alive at maternal admission to hospital and in live-born babies, but there were no differences when considering only babies admitted to NICU or survivors.ConclusionsNo difference in sensorimotor outcome for survivors of extremely preterm birth at 2 years of age was found according to the intensity of perinatal care provision. Active management of periviable births was associated with increased survival without sensorimotor disability.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1206-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Morgan

L’Hélias

Diguisto

et al. 2018

BMC Med

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“…In the Netherlands, several initiatives started to reduce the perinatal mortality rate. In 2010 active management for extremely preterm births at 24 weeks instead of at 25-26 weeks onwards began [8]. Also in 2010 a national perinatal audit program on term perinatal mortality started and within two years all 82 perinatal health care regions (hospital(s) and their surrounding primary care midwifery practices that are their preferred referring practices) participate in the national audit programme [9].…”

Section: Introductionmentioning

confidence: 99%

“…Main known risk factors for perinatal mortality are teenage pregnancy and advanced maternal age [18], smoking, non-Western ethnicity [19], socio-economic disadvantage [20], maternal obesity and complicated pregnancy history for instance preterm birth [3,8]. Women in Europe living under adverse socio-economic circumstances have twice the perinatal mortality risk.…”

Section: Introductionmentioning

confidence: 99%

Decreasing trend in preterm birth and perinatal mortality, do disparities also decline?

et al. 2020

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Background: In the Netherlands, several initiatives started after the publication of the PERISTAT findings that showed the perinatal mortality risk was higher than in other European countries. The objective of this study is 1) to report recent trends in perinatal mortality and in intermediate risk groups (preterm birth, congenital anomalies and small for gestational age (SGA)), 2) describing perinatal mortality risk among children born preterm, with congenital anomalies or SGA, and born in maternal high risk groups (parity, age, ethnicity and socioeconomic status (SES)). Methods: A nationwide cohort study in the Netherlands among 996,423 singleton births in 2010-2015 with a gestational age between 24.0 and 42.6 weeks. Trend tests, univariate and multivariable logistic regression analyses were used. We did separate analyses for gestational age subgroups and line of care. Results: The perinatal mortality rate was 5.0 per 1000 and it decreased significantly from 5.6 in 2010 to 4.6 per 1000 in 2015. Preterm birth significantly declined (6.1% in 2010 to 5.6% in 2015). Analysis by gestational age groups showed that the largest decline in perinatal mortality of 32% was seen at 24-27 weeks of gestation where the risk declined from 497 to 339 per 1000. At term, the decline was 23% from 2.2 to 1.7 per 1000. The smallest decline was 3% between 32 and 36 weeks. In children with preterm birth, congenital anomalies or SGA, the perinatal mortality risk significantly declined. Main risk factors for perinatal mortality were African ethnicity (adjusted odds ratio (aOR) 2.1 95%CI [1.9-2.4]), maternal age ≥ 40 years (aOR1.9 95%CI [1.7-2.2]) and parity 2 + (aOR 1.4 95%CI [1.3-1.5]). Among the (post)term born neonates, there was no significant decline in perinatal mortality in women with low age, low or high SES, non-Western ethnicity and among women who started or delivered under primary care. Conclusions: There is a decline in preterm birth and in perinatal mortality between 2010 and 2015. The decline in perinatal mortality is both in stillbirths and in neonatal mortality, most prominently among 24-27 weeks and among (post)term births. A possible future target could be deliveries among 32-36 weeks, women with high maternal age or non-Western ethnicity.

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“…4,5 Survival of very preterm infants in Romania is lower compared with centers in Western Europe. 6,7 The aim of this study was therefore to identify the changes in care and short-term morbidity and mortality rates for an extremely preterm infant population in Romania between two periods: 2007-2010 and [2011][2012][2013][2014].…”

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confidence: 99%

Trends in outcomes of very preterm infants in Romania: A tale of three cities

Suciu

Puşcaşiu

Cucerea

et al. 2017

Pediatrics International

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Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population‐based studies in ten European regions

Abstract: Changes in reported policies for management of extremely preterm births were related to mortality declines.

Cited by 22 publications

References 39 publications

Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Decreasing trend in preterm birth and perinatal mortality, do disparities also decline?

Trends in outcomes of very preterm infants in Romania: A tale of three cities

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