Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
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Use of evidence based practices to improve survival without severe morbidity for very preterm infants : results from the EPICE population based cohort. / Zeitlin, Jennifer; Manktelow, Bradley N; Piedvache, Aurelie; Cuttini, Marina; Boyle, Elaine; van Heijst, Arno; Gadzinowski, Janusz; Van Reempts, Patrick; Huusom, Lene; Weber, Tom; Schmidt, Stephan; Barros, Henrique; Dillalo, Dominico; Toome, Liis; Norman, Mikael; Blondel, Beatrice; Bonet, Mercedes; Draper, Elisabeth S; Maier, Rolf F.
In: B M J, Vol. 354, i2976, 2016.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Use of evidence based practices to improve survival without severe morbidity for very preterm infants
T2 - results from the EPICE population based cohort
AU - Zeitlin, Jennifer
AU - Manktelow, Bradley N
AU - Piedvache, Aurelie
AU - Cuttini, Marina
AU - Boyle, Elaine
AU - van Heijst, Arno
AU - Gadzinowski, Janusz
AU - Van Reempts, Patrick
AU - Huusom, Lene
AU - Weber, Tom
AU - Schmidt, Stephan
AU - Barros, Henrique
AU - Dillalo, Dominico
AU - Toome, Liis
AU - Norman, Mikael
AU - Blondel, Beatrice
AU - Bonet, Mercedes
AU - Draper, Elisabeth S
AU - Maier, Rolf F
N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
PY - 2016
Y1 - 2016
N2 - OBJECTIVES: To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity.DESIGN: Prospective multinational population based observational study.SETTING: 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project.PARTICIPANTS: 7336 infants born between 24+0 and 31+6 weeks' gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission.MAIN OUTCOME MEASURES: Combined use of four evidence based practices for infants born before 28 weeks' gestation using an "all or none" approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital.RESULTS: Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants.CONCLUSIONS: More comprehensive use of evidence based practices in perinatal medicine could result in considerable gains for very preterm infants, in terms of increased survival without severe morbidity.
AB - OBJECTIVES: To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity.DESIGN: Prospective multinational population based observational study.SETTING: 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project.PARTICIPANTS: 7336 infants born between 24+0 and 31+6 weeks' gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission.MAIN OUTCOME MEASURES: Combined use of four evidence based practices for infants born before 28 weeks' gestation using an "all or none" approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital.RESULTS: Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants.CONCLUSIONS: More comprehensive use of evidence based practices in perinatal medicine could result in considerable gains for very preterm infants, in terms of increased survival without severe morbidity.
KW - Europe
KW - Evidence-Based Practice
KW - Female
KW - Humans
KW - Infant, Extremely Premature
KW - Infant, Newborn
KW - Infant, Premature, Diseases
KW - Pregnancy
KW - Prospective Studies
KW - Survival Rate
KW - Journal Article
KW - Multicenter Study
KW - Observational Study
U2 - 10.1136/bmj.i2976
DO - 10.1136/bmj.i2976
M3 - Journal article
C2 - 27381936
VL - 354
JO - The BMJ
JF - The BMJ
SN - 0959-8146
M1 - i2976
ER -
ID: 180944583