Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions
M Bonet, M Cuttini, A Piedvache, EM Boyle, PH Jarreau, L Kollée, RF Maier, DWA Milligan, P Van Reempts, T Weber, H Barros, J Gadzinowki, ES Draper, J Zeitlin, the MOSAIC and EPICE research groups
Although the survival of infants born extremely preterm (before 27 weeks of gestation) has improved, the survival rates vary greatly across countries. This may reflect different policies for active treatment of these infants. The objective was to study mortality and morbidity in extremely preterm infants in relation to changes in maternity and neonatal unit policies in 10 European regions between 2003 and 2012, using data from the MOSAIC and EPICE cohorts.
43 of the 70 units studied had a more active management policy in 2012 compared to 2003, and 27 units had no change or a less active policy. The involvement of neonatologists at labour increased over time. During this period, in-hospital mortality decreased from 50.3% to 41.8% without an increase in major morbidities. Units that changed towards more active management had higher in-hospital mortality in 2003 (55%) compared to 2012 (43%) and a larger decline in mortality compared to units where policies stayed the same, although the mortality remained higher in these units.
Changes in policies towards more active management of extremely preterm infants have contributed to a decrease mortality, and this is an important aspect to consider when evaluating medical care for this population.
See article here: BJOG (2017)