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

Detalhes bibliográficos
Autor(a) principal: Zeitlin, J
Data de Publicação: 2016
Outros Autores: Manktelow, BN, Piedvache, A, Cuttini, M, Boyle, E, van Heijst, A, Gadzinowski, J, van Reempts, P, Huusom, L, Weber, T, Schmidt, S, Barros, H, Dillalo, D, Toome, L, Norman, M, Blondel, B, Bonet, M, Draper, ES, Maier, RF
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10216/114727
Resumo: 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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spelling Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohortVery preterm infantsMorbidityObjectives 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.20162016-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10216/114727eng1756-183310.1136/bmj.i2976Zeitlin, JManktelow, BNPiedvache, ACuttini, MBoyle, Evan Heijst, AGadzinowski, Jvan Reempts, PHuusom, LWeber, TSchmidt, SBarros, HDillalo, DToome, LNorman, MBlondel, BBonet, MDraper, ESMaier, RFinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-09-27T09:18:02Zoai:repositorio-aberto.up.pt:10216/114727Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-09-27T09:18:02Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
title Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
spellingShingle Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
Zeitlin, J
Very preterm infants
Morbidity
title_short Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
title_full Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
title_fullStr Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
title_full_unstemmed Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
title_sort Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
author Zeitlin, J
author_facet Zeitlin, J
Manktelow, BN
Piedvache, A
Cuttini, M
Boyle, E
van Heijst, A
Gadzinowski, J
van Reempts, P
Huusom, L
Weber, T
Schmidt, S
Barros, H
Dillalo, D
Toome, L
Norman, M
Blondel, B
Bonet, M
Draper, ES
Maier, RF
author_role author
author2 Manktelow, BN
Piedvache, A
Cuttini, M
Boyle, E
van Heijst, A
Gadzinowski, J
van Reempts, P
Huusom, L
Weber, T
Schmidt, S
Barros, H
Dillalo, D
Toome, L
Norman, M
Blondel, B
Bonet, M
Draper, ES
Maier, RF
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Zeitlin, J
Manktelow, BN
Piedvache, A
Cuttini, M
Boyle, E
van Heijst, A
Gadzinowski, J
van Reempts, P
Huusom, L
Weber, T
Schmidt, S
Barros, H
Dillalo, D
Toome, L
Norman, M
Blondel, B
Bonet, M
Draper, ES
Maier, RF
dc.subject.por.fl_str_mv Very preterm infants
Morbidity
topic Very preterm infants
Morbidity
description 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.
publishDate 2016
dc.date.none.fl_str_mv 2016
2016-01-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10216/114727
url http://hdl.handle.net/10216/114727
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 1756-1833
10.1136/bmj.i2976
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv mluisa.alvim@gmail.com
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