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Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study

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Smith, Lucy K ; Blondel, Beatrice ; Van Reempts, Patrick ; Draper, Elizabeth S ; Manktelow, Bradley N ; Barros, Henrique ; Cuttini, Marina ; Zeitlin, Jennifer ; EPICE Research Group ; Huusom, Lene Drasbek ; Weber, Tom. / Variability in the management and outcomes of extremely preterm births across five European countries : a population-based cohort study. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2017 ; Vol. 102, No. 5. pp. F400-F408.

Bibtex

@article{bdd0988b56d64619bfc0edb2e4b94634,
title = "Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study",
abstract = "OBJECTIVE: To explore international variations in the management and survival of extremely low gestational age and birthweight births.DESIGN: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22+0 and 25+6 weeks gestation born in 2011-2012.MAIN OUTCOME MEASURES: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).RESULTS: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision.CONCLUSIONS: Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines.",
keywords = "Cohort Studies, Drug Utilization, Europe, Female, Gestational Age, Glucocorticoids, Humans, Infant, Infant Mortality, Infant, Extremely Low Birth Weight, Infant, Extremely Premature, Infant, Newborn, Internationality, Live Birth, Male, Pregnancy, Prenatal Care, Respiration, Artificial, Comparative Study, Journal Article",
author = "Smith, {Lucy K} and Beatrice Blondel and {Van Reempts}, Patrick and Draper, {Elizabeth S} and Manktelow, {Bradley N} and Henrique Barros and Marina Cuttini and Jennifer Zeitlin and {EPICE Research Group} and Huusom, {Lene Drasbek} and Tom Weber",
note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.",
year = "2017",
month = sep,
doi = "10.1136/archdischild-2016-312100",
language = "English",
volume = "102",
pages = "F400--F408",
journal = "Archives of Disease in Childhood: Fetal and Neonatal Edition",
issn = "1359-2998",
publisher = "B M J Group",
number = "5",

}

RIS

TY - JOUR

T1 - Variability in the management and outcomes of extremely preterm births across five European countries

T2 - a population-based cohort study

AU - Smith, Lucy K

AU - Blondel, Beatrice

AU - Van Reempts, Patrick

AU - Draper, Elizabeth S

AU - Manktelow, Bradley N

AU - Barros, Henrique

AU - Cuttini, Marina

AU - Zeitlin, Jennifer

AU - EPICE Research Group

A2 - Huusom, Lene Drasbek

A2 - Weber, Tom

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2017/9

Y1 - 2017/9

N2 - OBJECTIVE: To explore international variations in the management and survival of extremely low gestational age and birthweight births.DESIGN: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22+0 and 25+6 weeks gestation born in 2011-2012.MAIN OUTCOME MEASURES: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).RESULTS: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision.CONCLUSIONS: Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines.

AB - OBJECTIVE: To explore international variations in the management and survival of extremely low gestational age and birthweight births.DESIGN: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22+0 and 25+6 weeks gestation born in 2011-2012.MAIN OUTCOME MEASURES: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).RESULTS: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision.CONCLUSIONS: Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines.

KW - Cohort Studies

KW - Drug Utilization

KW - Europe

KW - Female

KW - Gestational Age

KW - Glucocorticoids

KW - Humans

KW - Infant

KW - Infant Mortality

KW - Infant, Extremely Low Birth Weight

KW - Infant, Extremely Premature

KW - Infant, Newborn

KW - Internationality

KW - Live Birth

KW - Male

KW - Pregnancy

KW - Prenatal Care

KW - Respiration, Artificial

KW - Comparative Study

KW - Journal Article

U2 - 10.1136/archdischild-2016-312100

DO - 10.1136/archdischild-2016-312100

M3 - Journal article

C2 - 28232518

VL - 102

SP - F400-F408

JO - Archives of Disease in Childhood: Fetal and Neonatal Edition

JF - Archives of Disease in Childhood: Fetal and Neonatal Edition

SN - 1359-2998

IS - 5

ER -

ID: 52610455