Changes in care and outcome of very preterm babies in the Parisian region between 1998 and 2003

Jennifer Zeitlin ^1*, Pierre-Yves Ancel ¹, Dominique Delmas ¹, Gérard Bréart ¹ and Emile Papiernik ²

¹ INSERM U953, France
² Université Paris V Réné Descartes et Maternité de Port-Royal, Assistance-Publique Hôpitaux de Paris, France

^* To whom correspondence should be addressed. E-mail: jennifer.zeitlin{at}inserm.fr.

Accepted 5 April 2009

Abstract

Objective: To assess evolutions in the care and health of very preterm babies between 1998 and 2003 after implementation of a regionalisation policy in France.

Design: Comparison of two population-based cohorts.

Setting: The Parisian region.

Patients: All live births 24 to 31 weeks of gestation in 1997 (EPIPAGE study, N=488) and 2003 (MOSAIC study, N=580).

Interventions: Implementation of regionalised perinatal networks.

Main outcome measures: In-hospital mortality and morbidity, including intraventricular haemorrhage (IVH) grade III and IV, cystic periventricular leukomalacia (PVL) and bronchopulmonary dysplasia (BPD).

Results: Over this period, babies born in level III units rose from 67 to 77% and use of antenatal corticosteroids, indicated deliveries and surfactant increased. In-hospital mortality and intraventricular haemorrhage grades III/IV declined, ORs of 0.66 (95% CI: 0.46-0.95) and 0.27 (95% CI: 0.15-0.47) respectively, while periventricular leukomalacia and bronchopulmonary dysplasia stayed constant. The rate of very preterm babies discharged alive per 1000 total births increased by 18%, but declined for babies with severe brain lesions.

Conclusions: We found improvements in mortality and morbidity for very preterm babies and changes in their care over a 6 year period following reinforcement of regionalisation policies.