Publication
Title
Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012 : two population-based studies in ten European regions
Author
Institution/Organisation
Mosaic EPICE Res Grp
Abstract
Objective To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. Design Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. Setting 70 hospitals in ten European regions. Population Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). Methods We used McNemar's Chi(2) test, paired t-tests and conditional logistic regression for comparisons over time. Main outcomes measures Reported policies, mortality and morbidity of EPTIs. Results The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). Conclusions European hospitals reporting changes in management policies experienced larger survival gains for EPTIs.
Language
English
Source (journal)
BJOG: an international journal of obstetrics and gynaecology. - London
Publication
London : 2017
ISSN
1470-0328 [print]
1471-0528 [online]
DOI
10.1111/1471-0528.14639
Volume/pages
124 :10 (2017) , p. 1595-1604
ISI
000407971500026
Pubmed ID
28294506
Full text (Publisher's DOI)
Full text (open access)
Full text (publisher's version - intranet only)
UAntwerpen
Faculty/Department
Research group
Project info
EPICE: Effective Perinatal Intensive Care in Europe: translating knowledge into evidence based practice
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identifier
Creation 03.10.2017
Last edited 09.10.2023
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