Objective To assess evolution 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 at 24–31 weeks of gestation in 1997 (EPIPAGE study, n=488) and in 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 leucomalacia (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 IVH grades III/IV declined, ORs of 0.66 (95% CI 0.46 to 0.95) and 0.27 (95% CI 0.15 to 0.47), respectively, while PVL and BPD 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 The authors 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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↵* EPIPAGE Ile-de-France Group: Pierre-Yves Ancel, Gérard Breart, Michel Dehan, Monique Kaminski, Christiane Du Mazaubrun, Michel Vodovar, Marcel Voyer, Véronique Zupan-Simunek; MOSAIC Ile-de-France Group: Gérard Breart, Jean-Louis Chabernaud, Dominique Delmas, Pierre-Henri Jarreau, Emile Papernik, Jennifer Zeitlin.
Funding This MOSAIC project was partially funded by a grant from the European Commission Research Directorate (QLG4-CT-2001-01907). The EPIPAGE study was supported by grants from INSERM (National Institute of Health and Medical Research), the Directorate General for Health of the Ministry for Social Affairs, Merck-Sharp and Dhome-Chibret, Medical Research Foundation, HAS (French National Authority for Health) and “Hospital Program for Clinical Research 2001 number AOMO1117” of the French Ministry of Health.
Competing interests None.
Ethics approval This study was conducted with the approval of the Commission Nationale de l’Informatique et des Libertés (the French data protection agency).
Provenance and peer review Not commissioned; externally peer reviewed.
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