Article Text

Download PDFPDF
Mortality and significant neurosensory impairment in preterm infants: an international comparison
  1. Marie Chevallier1,2,
  2. Thierry Debillon1,2,
  3. Brian A Darlow3,
  4. Anne R Synnes4,
  5. Véronique Pierrat5,6,
  6. Elizabeth Hurrion7,
  7. Junmin Yang8,
  8. Anne Ego2,9,10,
  9. Pierre Yves Ancel5,11,
  10. Kei Lui12,
  11. Prakeshkumar S Shah8,13,
  12. Thuy Mai Luu14,
  13. Australian and New Zealand Neonatal Network (ANZNN),
  14. Canadian Neonatal Network (CNN),
  15. Canadian Neonatal Follow-Up Network (CNFUN)
  16. Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE-2) Investigators
          1. 1 Neonatal Intensive Care Unit, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France
          2. 2 TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
          3. 3 Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
          4. 4 Department of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
          5. 5 Obstetrical Perinanal And Pediatric Epidemiology Research team (EPOPé), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Paris, Île-de-France, France
          6. 6 Departement of Neonatal medicine, Lille University Hospital, Lille, France
          7. 7 Department of Newborn Services, Mater Mothers Hospital and Mater Medical Research Institute, South Brisbane, Queensland, Australia
          8. 8 Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
          9. 9 CIC U1406, INSERM, Grenoble, France
          10. 10 Department of Public Health, Grenoble Alps University Hospital, Grenoble, France
          11. 11 Clinical Investigation center P1419, Paris Public Assistance Hospital, Paris, France
          12. 12 Department of Newborn Care, Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Sydney, New South Wales, Australia
          13. 13 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
          14. 14 Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
          1. Correspondence to Dr Marie Chevallier, Neonatal intensive care unit, Grenoble Alpes University Hospital Centre Couples and Children Section, Grenoble, France; MChevallier3{at}chu-grenoble.fr

          Abstract

          Objective To compare mortality and rates of significant neurosensory impairment (sNSI) at 18–36 months’ corrected age in infants born extremely preterm across three international cohorts.

          Design Retrospective analysis of prospectively collected neonatal and follow-up data.

          Setting Three population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).

          Patients Extremely preterm neonates of <28 weeks’ gestation in year 2011.

          Main outcome measures Primary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.

          Results Overall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants’ baseline characteristics).

          Conclusions Composite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.

          • neonatology
          • neurology

          Data availability statement

          No data are available.

          Statistics from Altmetric.com

          Data availability statement

          No data are available.

          View Full Text

          Footnotes

          • Collaborators ANZNN Site Investigators: Kei Lui* Chair of ANZNN. Flinders Medical Centre, South Australia (SA): Peter Marshall. Gold Coast University Hospital, Queensland (QLD): Peter Schmidt. Blacktown District Hospital, New South Wales (NSW): Anjali Dhawan*. John Hunter Children’s Hospital, NSW: Larissa Korostenski, Javeed Travadi*. King Edward Memorial and Perth Children’s Hospitals, Western Australia (WA): Mary Sharp, Andy Gill*, Jane Pillow*. Liverpool Hospital, NSW: Jacqueline Stack. Mater Mothers' Hospital, QLD: Pita Birch, Karen Nothdurft*. Neonatal Retrieval Emergency Service Southern Queensland, QLD: Lucy Cooke*. Mercy Hospital for Women, Victoria (VIC): Dan Casalaz, Jim Holberton*. Monash Medical Centre, VIC: Alice Stewart. Nepean Hospital, NSW: Lyn Downe. Paediatric Infant Perinatal Emergency Retrieval (VIC): Michael Stewart. NSW Newborn & Paediatric Emergency Transport Service: Andrew Berry. Royal Children's Hospital, VIC: Rod Hunt*. Royal Darwin Hospital,

            Northern Territory (NT): Peter Morris. Royal Hobart Hospital, Tasmania: Tony De Paoli. Royal Hospital for Women, NSW: Kei Lui* and Srinivas Bolisetty. Royal North Shore Hospital, NSW: Mary Paradisis. Royal Prince Alfred Hospital, NSW: Mark Greenhalgh. Royal Brisbane and Women's Hospital, QLD: Pieter Koorts. Royal Women's Hospital, VIC: Carl Kuschel, Sue Jacobs and Lex Doyle. SAAS MedSTAR Emergency Medical Retrieval Services: John Craven. Sydney Children's Hospital, NSW: Andrew Numa. The Canberra Hospital, ACT: Hazel Carlisle. The Children's Hospital at Westmead, NSW: Nadia Badawi and Himanshu Popat. The Townsville Hospital, QLD: Guan Koh. Neonatal Emergency Transport Service of Western Australia: Jonathan Davis. Westmead Hospital, NSW: Melissa Luig. Women's & Children's Hospital, SA: Bevan Headley and Chad Andersen*. Australian College of Neonatal Nurses: Linda Ng*. National Perinatal Epidemiology and Statistics Unit, University of New South Wales: Georgina Chambers*. New Zealand: Christchurch Women's Hospital: Nicola Austin and Adrienne Lynn. University of Otago, Christchurch: Brian Darlow. Dunedin Hospital: Liza Edmonds. Middlemore Hospital: Lindsay Mildenhall. Auckland City Hospital: Mariam Buksh and Malcolm Battin*. Waikato Hospital: Jutta van den Boom. Wellington Women's Hospital: Vaughan Richardson. Whangarei Hospital: David Barker*. Neonatal Nurses College Aotearoa: Barbara Hammond*. Singapore: KK Women's and Children's Hospital, Singapore: Victor Samuel Rajadurai*. Hong Kong: Prince of Wales Hospital: Simon Lam. United Christian Hospital: Genevieve Fung. Asterisk (*) denotes the ANZNN Executive Committee; The ANZNN Follow up Subcommittee members (regional representatives): Elizabeth Hurrion (Chair, Queensland), Peter Anderson (Developmental psychologist), Nicola Austin (New Zealand), Jeanie Cheong (Victoria), Vanessa Ellison (South Australia and Northern Territory), Mary Sharp (Western Australia) and Ingrid Rieger (New South Wales and Australian Capital Territory). Lex Doyle (Victoria) stepped down for Jeanie Cheong in 2020. CNN Site Investigators: Prakesh S Shah, MD, MSc (Director, Canadian Neonatal Network and Site Investigator), Mount Sinai Hospital, Toronto, Ontario; Marc Beltempo, MD (Associate Director, Canadian Neonatal Network and Site Investigator), Montreal Children’s Hospital at McGill University Health Centre, Montréal, Québec; Jaideep Kanungo, MD, Victoria General Hospital, Victoria, British Columbia; Joseph Ting, MD, British Columbia Women’s Hospital, Vancouver, British Columbia; Zenon Cieslak, MD, Royal Columbian Hospital, New Westminster, British Columbia; Rebecca Sherlock, MD, Surrey Memorial Hospital, Surrey, British Columbia; Ayman Abou Mehrem, MD, Foothills Medical Centre, Calgary, Alberta; Jennifer Toye, MD and Khalid Aziz, MBBS, Royal Alexandra Hospital, Edmonton, Alberta; Carlos Fajardo, MD, Alberta Children’s Hospital, Calgary, Alberta; Jaya Bodani, MD, Regina General Hospital, Regina, Saskatchewan; Lannae Strueby, MD, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, MBChB and Deepak Louis, MD, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, MD, St. Boniface General Hospital, Winnipeg, Manitoba; Amit Mukerji, MD, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, MD, MSc, London Health Sciences Centre, London, Ontario; Sajit Augustine, MD, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, MD, MSc, Hospital for Sick Children, Toronto, Ontario; Eugene Ng, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Brigitte Lemyre, MD, The Ottawa Hospital, Ottawa, Ontario; Thierry Daboval, MD, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; Faiza Khurshid, MD, Kingston General Hospital, Kingston, Ontario; Victoria Bizgu, MD, Jewish General Hospital, Montréal, Québec; Keith Barrington, MBChB, Anie Lapointe, MD, and Guillaume Ethier, NNP, Hôpital Sainte-Justine, Montréal, Québec; Christine Drolet, MD, and Bruno Piedboeuf, MD, Centre Hospitalier Universitaire de Québec, Sainte Foy, Québec; Martine Claveau, MSc, LLM, NNP, Montreal Children’s Hospital at McGill University Health Centre, Montréal, Québec; Marie St-Hilaire, MD, Hôpital Maisonneuve-Rosemont, Montréal, Québec; Valerie Bertelle, MD, and Edith Masse, MD, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Roderick Canning, MD, Moncton Hospital, Moncton, New Brunswick; Hala Makary, MD, Dr Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah, MBBS, and Luis Monterrosa, MD, Saint John Regional Hospital, Saint John, New Brunswick; Julie Emberley, MD, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland; Jehier Afifi, MB BCh, MSc, IWK Health Centre, Halifax, Nova Scotia; Andrzej Kajetanowicz, MD, Cape Breton Regional Hospital, Sydney, Nova Scotia; Shoo K Lee, MBBS, PhD (Chairman, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario. CNFUN Site Investigators and Steering Committee: Thevanisha Pillay, MD, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, MDCM, MHSC (director) and Ruth Grunau, PhD (steering committee) British Columbia Women’s Hospital, Vancouver, British Columbia; Jill Zwicker, PhD (steering committee); Rebecca Sherlock, MD, Surrey Memorial Hospital, Surrey, British Columbia; Miroslav Stavel, MD, Anitha Moodley, MD, Royal Columbian Hospital, New Westminister, British Columbia; Leonora Hendson, MB.BCH, MSc, Alberta’s Children’s Hospital, Foothills Medical Centre, Calgary, Alberta; Amber Reichert, MD, Matthew Hicks, MD, PhD, Glenrose Rehabilitation Hospital, Edmonton, Alberta; Jaya Bodani, MD, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, MD, Royal University Hospital, Saskatoon, Saskatchewan; Diane Moddemann, MD (steering committee), Cecilia de Cabo, MD, Winnipeg Health Sciences Centre, St. Boniface General Hospital, Winnipeg, Manitoba; Chukwuma Nwaesei, MD, Windsor Regional Hospital, Windsor, Ontario; Thierry Daboval, MD, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; Sarah McKnight, MD, Kingston General Hospital, Kingston, Ontario; Kevin Coughlin, MD (steering committee), Lynn Whitty RN (steering committee), Children’s Hospital London Health Sciences Centre, London, Ontario; Linh Ly, MD, Hospital for Sick Children, Toronto, Ontario; Edmond Kelly, MD, Mount Sinai Hospital, Toronto, Ontario; Karen Thomas, MD, Hamilton Health Sciences Centre, Hamilton, Ontario; Paige Church, MD, Rudaina Banihani MD (steering committee) Sunnybrook Health Sciences Centre, Toronto, Ontario; Ermelinda Pelausa, MD, Kim-Anh Nguyen MD, Jewish General Hospital, Montréal, Québec; May Khairy, MD, Marc Beltempo, MD, Montréal Children’s Hospital, Royal Victoria Hospital, Montréal, Québec; Veronique Dorval, MD, Thuy Mai Luu, MD, MSc (codirector), Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec; Charlotte Demers, MD, Alyssa Morin MD, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Sylvie Bélanger, MD, Centre Hospitalier Universitaire de Québec, Québec City, Québec; Roderick Canning, MD, Moncton Hospital, Moncton, New Brunswick; Luis Monterrosa, MD, Saint John Regional Hospital, Saint John, New Brunswick; Hala Makary, MD, Dr Everett Chalmers Hospital, Fredericton, New Brunswick; Jehier Afifi, MB BCh, MSc, (steering committee) IWK Health Centre, Halifax, Nova Scotia; Phil Murphy, Charles Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland. EPIPAGE-2 Study group – 2 years follow-up; Alsace: D Astruc, P Kuhn, B Langer, J Matis and C Ramousset; Aquitaine: X Hernandorena, P Chabanier, L Joly-Pedespan, M J Costedoat and A Leguen; Auvergne: B Lecomte, D Lemery and F Vendittelli; Basse-Normandie: G Beucher, M Dreyfus, B Guillois and Y Toure; Bourgogne: A Burguet, S Couvreur, J B Gouyon, P Sagot and N Colas; Bretagne: J Sizun, A Beuchée, P Pladys, F Rouget, R P Dupuy, D Soupre, F Charlot and S Roudaut; Centre: A Favreau, E Saliba and L Reboul; Champagne-Ardenne: N Bednarek, P Morville and V Verrière; Franche-Comté: G Thiriez and C Balamou; Haute-Normandie: L Marpeau, S Marret and C Barbier; Ile-de-France: G Kayem, X Durrmeyer, M Granier, M Ayoubi, O Baud, B Carbonne, L Foix L’Hélias, F Goffinet, P H Jarreau, D Mitanchez, P Boileau, C Duffaut, E Lorthe, L Cornu and R Moras; Languedoc-Roussillon: P Boulot, G Cambonie, H Daudé, A Badessi and N Tsaoussis; Limousin: A Bédu, F Mons and C Bahans; Lorraine: M H Binet, J Fresson, J M Hascoët, A Milton, O Morel, R Vieux and L Hilpert; Midi-Pyrénées: C Alberge, C Arnaud, C Vayssière and M Baron; Nord-Pas-de-Calais: M L Charkaluk, V Pierrat, D Subtil, P Truffert and S Akowanou; PACA et Corse: C D’Ercole, C Gire, U Simeoni, A Bongain and M Deschamps; Pays de Loire: B Branger, J C Rozé, N Winer, V Rouger and C Dupont; Picardie: J Gondry, G Krim and B Baby; Rhône-Alpes: M Debeir, O Claris, J C Picaud, S Rubio-Gurung, C Cans, A Ego, T Debillon, H Patural and A Rannaud; Guadeloupe: E Janky, A Poulichet, J M Rosenthal and E Coliné; Guyane: A Favre and N Joly; Martinique: S Châlons, J Pignol and P L Laurence; La Réunion: P Y Robillard, S Samperiz and D Ramful. Inserm UMR 1153: P Y Ancel, V Benhammou, B Blondel, M Bonet, A Brinis, A Coquelin, M Durox, M Kaminski, K Khemache, B Khoshnood, C Lebeaux, L Marchand-Martin, J Rousseau, M J Saurel-Cubizolles, D Tran and J Zeitlin.

          • 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; and (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, authors have confidence in the integrity of the contributions of their coauthors. MC conceptualised and designed the study, acquired and interpreted the data, drafted the manuscript and critically revised the manuscript for important intellectual content. JY conducted the statistical analysis, interpreted the data and critically revised the manuscript. PSS and TML conceptualised and designed the study, 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. TD, BAD, ARS, VP, EH, AE, PYA, and KL interpreted the study data and critically reviewed and revised the manuscript for important intellectual content.

          • Funding EPIPAGE-2 has been funded with support from the following organisations: The 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 (INSERM), the National Institute of Cancer and the National Solidarity Fund for Autonomy (CNSA); The National Research Agency through the French EQUIPEX program of investments in the future (ANR-11-EQPX-0038); the PREMUP Foundation; Fondation de France (00050329); Fondation pour la Recherche Médicale (SPF20160936356). The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from the participating centers. The Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network are supported by the participating centers and receive organisational support from the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research team grant (CTP 87518), the Ontario Ministry of Health and Long-Term Care and Mount Sinai Hospital.

          • Disclaimer The funding bodies had no role in the design or conduct of the study; the collection, management, analysis or interpretation of the data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.

          • Competing interests None declared.

          • Provenance and peer review Not commissioned; externally peer reviewed.

          • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

          Request Permissions

          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.