Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation
Objective To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/6/1/e001619.full |
| _version_ | 1797980310762160128 |
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| author | François Goffinet Pierre-Yves Ancel Stéphane Dauger Peter Jones Laetitia Marchand-Martin Andrei Scott Morgan Jeanne Fresson Caroline Diguisto Thomas Desplanches |
| author_facet | François Goffinet Pierre-Yves Ancel Stéphane Dauger Peter Jones Laetitia Marchand-Martin Andrei Scott Morgan Jeanne Fresson Caroline Diguisto Thomas Desplanches |
| author_sort | François Goffinet |
| collection | DOAJ |
| description | Objective To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for.Design Individual matched study nested within a prospective cohort. Each outborn infant was matched using GA and antenatal steroids with a maximum of four inborns. Conditional logistic regression was used to calculate ORs before being adjusted using maternal and birth characteristics. Analyses were carried out after multiple imputation for missing data.Setting EPIPAGE-2 French national prospective cohort including births up to 34 weeks GA inclusive.Patients Outborn and inborn control infants selected between 24 and 31 weeks GA were followed in the neonatal period and to 2 and 5.5 years. 3335 infants were eligible of whom all 498 outborns and 1235 inborn infants were included—equivalent to 2.5 inborns for each outborn.Main outcome measure Survival without moderate-to-severe neurodevelopmental impairment at 5.5 years.Results Chorioamnionitis, pre-eclampsia, caesarian birth and small-for-dates were more frequent among inborns, and spontaneous labour and antepartum haemorrhage among outborns. There was no difference in the main outcome measure at 5.5 years of age (adjusted OR 1.09, 95% CI 0.82 to 1.44); sensitivity analyses suggested improved outcomes at lower GAs for inborns.Conclusion In this GA and steroid matched cohort, there was no difference in survival without moderate-to-severe neurodevelopmental impairment to 5.5 years of age between inborn and outborn very preterm children. This suggests steroids might be important in determining outcomes. |
| first_indexed | 2024-04-11T05:53:34Z |
| format | Article |
| id | doaj.art-cad4eb1e7861454f872f867348bc7365 |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-04-11T05:53:34Z |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-cad4eb1e7861454f872f867348bc73652022-12-22T04:42:00ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722022-12-016110.1136/bmjpo-2022-001619Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputationFrançois Goffinet0Pierre-Yves Ancel1Stéphane Dauger2Peter Jones3Laetitia Marchand-Martin4Andrei Scott Morgan5Jeanne Fresson6Caroline Diguisto7Thomas Desplanches8professor in obstetrics and gynaecologyObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France1 PICU (SMUR) Réanimation Pédiatrique, Assistance Publique – Hôpitaux de Paris, Hôpital Robert Debré, Paris, FranceNHS Professional Bank, NHS Professionals Special Health Authority, Watford, Hertfordshire, UKstatisticianneonatologist and epidemiologist5Maternité Régionale Universitaire, Nancy Cedex, France1 Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tonnellé, FranceObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, FranceObjective To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for.Design Individual matched study nested within a prospective cohort. Each outborn infant was matched using GA and antenatal steroids with a maximum of four inborns. Conditional logistic regression was used to calculate ORs before being adjusted using maternal and birth characteristics. Analyses were carried out after multiple imputation for missing data.Setting EPIPAGE-2 French national prospective cohort including births up to 34 weeks GA inclusive.Patients Outborn and inborn control infants selected between 24 and 31 weeks GA were followed in the neonatal period and to 2 and 5.5 years. 3335 infants were eligible of whom all 498 outborns and 1235 inborn infants were included—equivalent to 2.5 inborns for each outborn.Main outcome measure Survival without moderate-to-severe neurodevelopmental impairment at 5.5 years.Results Chorioamnionitis, pre-eclampsia, caesarian birth and small-for-dates were more frequent among inborns, and spontaneous labour and antepartum haemorrhage among outborns. There was no difference in the main outcome measure at 5.5 years of age (adjusted OR 1.09, 95% CI 0.82 to 1.44); sensitivity analyses suggested improved outcomes at lower GAs for inborns.Conclusion In this GA and steroid matched cohort, there was no difference in survival without moderate-to-severe neurodevelopmental impairment to 5.5 years of age between inborn and outborn very preterm children. This suggests steroids might be important in determining outcomes.https://bmjpaedsopen.bmj.com/content/6/1/e001619.full |
| spellingShingle | François Goffinet Pierre-Yves Ancel Stéphane Dauger Peter Jones Laetitia Marchand-Martin Andrei Scott Morgan Jeanne Fresson Caroline Diguisto Thomas Desplanches Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation BMJ Paediatrics Open |
| title | Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation |
| title_full | Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation |
| title_fullStr | Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation |
| title_full_unstemmed | Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation |
| title_short | Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation |
| title_sort | survival and neurodevelopmental impairment of outborn preterm infants at 5 5 years of age an epipage 2 prospective matched study using multiple imputation |
| url | https://bmjpaedsopen.bmj.com/content/6/1/e001619.full |
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