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Observational Study
. 2016 Jul 5:354:i2976.
doi: 10.1136/bmj.i2976.

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort

Jennifer Zeitlin  1 , Bradley N Manktelow  2 , Aurelie Piedvache  3 , Marina Cuttini  4 , Elaine Boyle  2 , Arno van Heijst  5 , Janusz Gadzinowski  6 , Patrick Van Reempts  7 , Lene Huusom  8 , Tom Weber  8 , Stephan Schmidt  9 , Henrique Barros  10 , Dominico Dillalo  11 , Liis Toome  12 , Mikael Norman  13 , Beatrice Blondel  3 , Mercedes Bonet  3 , Elisabeth S Draper  2 , Rolf F Maier  14 ; EPICE Research Group
Affiliations
Observational Study

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort

Jennifer Zeitlin et al. BMJ. .

Abstract

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Receipt of each evidence based intervention in all or none composite as well as receipt of all interventions among infants of 24+0 to 31+6 weeks’ gestation admitted to neonatal care. CPAP=continuous positive airway pressure
See this image and copyright information in PMC

Comment in

References

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