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Less than 60% of very preterm infants receive evidence-based practices
According to study findings, only 58.3% of eligible very preterm infants in Europe received four high-evidence practices intended to reduce their risks for neonatal mortality and morbidity.
“Ensuring the best outcomes for very preterm infants is essential for their future health and development and for reducing the burden for families and health care and social systems,” Jennifer Zeitlin, DSc, senior research scientist at the Center for Epidemiology and Biostatistics, Paris, and colleagues wrote. “Very preterm infants — those born before 32 weeks’ gestation —represent fewer than 2% of all births but up to half of infant deaths.”
To assess the impact of high-evidence practices in routine clinical practice and whether they constitute a driver for reducing neonatal morbidity and mortality in this population, the researcher evaluated the implementation of four of 17 Effective Perinatal Intensive Care in Europe (EPICE) protocols. These included:
- delivery in a maternity unit with adequate on-site neonatal intensive care facilities;
- giving antenatal corticosteroids to reduce complications of prematurity;
- preventing hypothermia; and
- early treatment for breathing difficulties.
Zeitlin and colleagues examined data from 7,336 infants who were included among the 850,000 annual births participating in the EPICE project in 11 European countries. The participants were born between 24 weeks’ and 31 weeks, 6 days’ gestation in 2011 to 2012; all were born without serious congenital anomalies and survived to neonatal admission.
The researchers determined that 4,275 infants received all evidence-based practices for which they were eligible. This care resulted in reduced in-hospital mortality (adjusted RR = 0.72, 95% CI, 0.6-0.87), severe morbidity (aRR = 0.82; 95% CI, 0.71-0.94), or both (aRR = 0.81; 95% CI, 0.72-0.9). Further, utilizing these interventions resulted in an estimated 18% decrease in all deaths without an increase in severe morbidity.
Zeitlin and colleagues wrote that infants with low gestational age, growth restriction, low Apgar scores, and those born on the day of maternal hospital admission were less likely to receive evidence-based care.
“These results suggest that more comprehensive use of these high-evidence and widely accessible practices could yield substantial gains in survival without severe morbidity for these infants at high risk,” the investigators said. – by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.
