Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study
Abstract 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 ha...
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| Format: | Article |
| Language: | English |
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BMC
2020-01-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-019-1856-1 |
| _version_ | 1830187589153325056 |
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| author | Andrei Scott Morgan Babak Khoshnood Caroline Diguisto Laurence Foix L’Helias Laetitia Marchand-Martin Monique Kaminski Jennifer Zeitlin Gérard Bréart François Goffinet Pierre-Yves Ancel |
| author_facet | Andrei Scott Morgan Babak Khoshnood Caroline Diguisto Laurence Foix L’Helias Laetitia Marchand-Martin Monique Kaminski Jennifer Zeitlin Gérard Bréart François Goffinet Pierre-Yves Ancel |
| author_sort | Andrei Scott Morgan |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-17T22:29:44Z |
| format | Article |
| id | doaj.art-a36498e48b83461bbe00ca3ea758ba96 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-17T22:29:44Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
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| series | BMC Pediatrics |
| spelling | doaj.art-a36498e48b83461bbe00ca3ea758ba962022-12-21T21:30:13ZengBMCBMC Pediatrics1471-24312020-01-0120111010.1186/s12887-019-1856-1Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort studyAndrei Scott Morgan0Babak Khoshnood1Caroline Diguisto2Laurence Foix L’Helias3Laetitia Marchand-Martin4Monique Kaminski5Jennifer Zeitlin6Gérard Bréart7François Goffinet8Pierre-Yves Ancel9Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAUniversité de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153 – Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRAAbstract 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.https://doi.org/10.1186/s12887-019-1856-1Extreme prematurityNewbornPerinatal intensityActivityObstetricNeonatal |
| spellingShingle | Andrei Scott Morgan Babak Khoshnood Caroline Diguisto Laurence Foix L’Helias Laetitia Marchand-Martin Monique Kaminski Jennifer Zeitlin Gérard Bréart François Goffinet Pierre-Yves Ancel Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study BMC Pediatrics Extreme prematurity Newborn Perinatal intensity Activity Obstetric Neonatal |
| title | Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study |
| title_full | Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study |
| title_fullStr | Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study |
| title_full_unstemmed | Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study |
| title_short | Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study |
| title_sort | intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age evidence from the epipage 2 cohort study |
| topic | Extreme prematurity Newborn Perinatal intensity Activity Obstetric Neonatal |
| url | https://doi.org/10.1186/s12887-019-1856-1 |
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