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Abstract
Objective The aim of this study was to investigate variations in mortality before neonatal intensive care unit (NICU) discharge of infants born preterm with intraparenchymal haemorrhage (IPH) in Europe with a special interest for withdrawing life-sustaining therapy (WLST).
Design Secondary analysis of the Effective Perinatal Intensive Care in Europe (EPICE) cohort, 2011–2012.
Setting Nineteen regions in 11 European countries.
Patients All infants born between 24+0 and 31+6 weeks’ gestational age (GA) with a diagnosis of IPH.
Main outcome measures Mortality rate with multivariable analysis after adjustment for GA, antenatal steroids and gender. WLST policies were described among NICUs and within countries.
Results Among 6828 infants born alive between 24+0 and 31+6 weeks’ GA and without congenital anomalies admitted to NICUs, IPH was diagnosed in 234 infants (3.4%, 95% CI 3.3% to 3.9%) and 138 of them (59%) died. The median age at death was 6 days (3–13). Mortality rates varied significantly between countries (extremes: 30%–81%; p<0.004) and most infants (69%) died after WLST. After adjustment and with reference to the UK, mortality rates were significantly higher for France, Denmark and the Netherlands, with ORs of 8.8 (95% CI 3.3 to 23.6), 5.9 (95% CI 1.6 to 21.4) and 4.8 (95% CI 1.1 to 8.9). There were variations in WLST between European regions and countries.
Conclusion In infants with IPH, rates of death before discharge and death after WLST varied between European countries. These variations in mortality impede studying reliable outcomes in infants with IPH across European countries and encourage reflection of clinical practices of WLST across European units.
- Mortality
- Neonatology
- Palliative Care
- Epidemiology
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Data can be shared on request with EPICE’s main investigator in France.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Data can be shared on request with EPICE’s main investigator in France.
Footnotes
Collaborators EPICE AND SHIPS RESEARCH GROUP: J Lebeer, P Van Reempts, E Bruneel, E Cloet, A Oostra, E Ortibus, I Sarrechia, K Boerch, L Huusom, P Pedersen, T Weber, L Toome, H Varendi, M Ma ̈nnamaa, PY Ancel, A Burguet, PH Jarreau, V Pierrat, P Truffert, RF Maier, H Ehrhardt, M Zemlin, B Misselwitz, S Schmidt, L Wohlers, M Cuttini, D Di Lallo, G Ancora, D Baronciani, V Carnielli, I Croci, G Faldella, F Ferrari, F Franco, G Gargano, A van Heijst, C Koopman-Esseboom, J Gadzinowski, J Mazela, A Montgomery, T Pikuła, H Barros, R Costa, L Mendes Grac ̧a, M do Ce ́u Machado, C Rodrigues, T Rodrigues, U Aden, AK Edstedt Bonamy, M Norman, ES Draper, EM Boyle, A Fenton, SJ Johnson, BN Manktelow, DWA Milligan, S Mader, N Thiele, JM Walz, S Petrou, J Zeitlin, AM Aubert, M Bonet, C Bonnet, R El Raffei, A Piedvache, AV Seppanen.
Contributors All authors meet the four criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; (2) drafting the work or revising it critically for important intellectual content; (3) final approval of the version to be published; (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors can identify which coauthors are responsible for specific other parts of the work. In addition, the authors have confidence in the integrity of the contributions of their coauthors. MC and HT conceptualised and designed the study. LT, CL, AE and AMA conducted the statistical analysis, interpreted the data and critically revised the manuscript. VP, JZ and MC contributed to the statistical analysis and interpreted the data, critically revised the manuscript for important intellectual content and provided technical support and overall study supervision. LT and TD interpreted the study data and critically reviewed and revised the manuscript for important intellectual content. MC accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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