Objective To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.
Design Area-based cohort study of all births before 32 weeks of gestational age.
Setting 16 regions in 11 European countries in 2011/2012.
Patients Survivors to discharge from neonatal care (n=6422).
Main outcome measures Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics.
Results 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%–23.5%) and 13.8% including severe BPD (regional range 10.0%–23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%–18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50).
Conclusion Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
AKEB and JZ contributed equally.
Contributors AKEB and JZ had access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AKEB, JZ, AP, RFM, AvH, HV, LK, BNM, AF, JM, MC, SP, PVR, HB, ESD; acquisition, analysis or interpretation of data: AKEB, JZ, AP, RFM, AvH, HV, BM, AF, JM, MC, SP, PVR, HB, ESD and all authors in the Epice Research Group; drafting of the manuscript: AKEB, JZ, AP, RFM, AvH, HV, BM, AF, JM, MC, SP, PVR, HB, ESD; critical revision of the manuscript for important intellectual content and approval of final version of the manuscript: All authors (including investigators listed in Epice Research Group); statistical analysis: AKEB, JZ, AP. Final approval: all authors.
Funding The research leading to these results received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°259882. Additional funding is acknowledge from the following regions: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future; and the Prem Up Foundation); Poland (2012- 2015 allocation of funds for international projects from the Polish Ministry of Science and Higher Education); Sweden (Stockholm County Council (ALF-project and Clinical Research Appointment) and by the Department of Neonatal Medicine, Karolinska University Hospital), UK (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire and Humber regions).
Competing interests None declared.
Ethics approval French Advisory Committee on Use of Health Data in Medical Research and the French National Commission for Data Protection and Liberties. Also, ethics authorisation was obtained for each study in the participating regions.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Access to data in the EPICE cohort for researchers who are not members of the consortium is not currently possible, but EPICE is part of a H2020 project (RECAP, https://recap-preterm.eu/) to develop a Platform for data sharing. Please contact the corresponding author for more information.
Collaborators BELGIUM: Flanders (E Martens, G Martens, P Van Reempts); DENMARK: Eastern Region (K Boerch, A Hasselager, L Huusom, O Pryds, T Weber); ESTONIA (L Toome, H Varendi); FRANCE: Burgundy, Ile-de France and Northern Region (PY Ancel, B Blondel, A Burguet, PH Jarreau, P Truffert); GERMANY: Hesse (RF Maier, B Misselwitz, S Schmidt), Saarland (L Gortner); ITALY: Emilia Romagna (D Baronciani, G Gargano), Lazio (R Agostino, D DiLallo, F Franco), Marche (V Carnielli), M Cuttini; ; NETHERLANDS: Eastern & Central (C Koopman-Esseboom, A Van Heijst, J Nijman); POLAND: Wielkopolska (J Gadzinowski, J Mazela); PORTUGAL: Lisbon and Tagus Valley (LM Graça, MC Machado), Northern region (Carina Rodrigues, T Rodrigues), H Barros; SWEDEN: Stockholm (AK Bonamy, M Norman, E Wilson); UK: East Midlands and Yorkshire and Humber (E Boyle, ES Draper, BN Manktelow), Northern Region (AC Fenton, DWA Milligan); INSERM, Paris (J Zeitlin, M Bonet, A Piedvache).
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.