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Changes in care and outcome of very preterm babies in the Parisian region between 1998 and 2003
  1. Jennifer Zeitlin (jennifer.zeitlin{at}
  1. INSERM U953, France
    1. Pierre-Yves Ancel (pierre-yves.ancel{at}
    1. INSERM U953, France
      1. Dominique Delmas (dominique.delmas{at}
      1. INSERM U953, France
        1. Gérard Bréart (gerard.breart{at}
        1. INSERM U953, France
          1. Emile Papiernik (emile.papiernik{at}
          1. Université Paris V Réné Descartes et Maternité de Port-Royal, Assistance-Publique Hôpitaux de Paris, France


            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.

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