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Evidence-based neonatal unit practices and determinants of Postnatal corticosteroid-use in preterm births below 30 weeks ga in Europe. A population-based cohort study

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posted on 2017-03-22, 13:56 authored by Alexandra Nuytten, Hélène Behal, Alain Duhamel, Pierre-Henri Jarreau, Jan Mazela, David Milligan, Ludwig Gortner, Aurélie Piedvache, Jennifer Zeitlin, Patrick Truffert, E. Martens, G. Martens, P. Van Reempts, K. Boerch, A. Hasselager, L. Huusom, O. Pryds, T. Weber, L. Toome, H. Varendi, P. Y. Ancel, B. Blondel, A. Burguet, P. H. Jarreau, P. Truffert, R. F. Maier, B. Misselwitz, S. Schmidt, L. Gortner, D. Baronciani, G. Gargano, R. Agostino, D. DiLallo, F. Franco, V. Carnielli, C. Koopman-Esseboom, A. Van Heijst, J. Nijman, J. Gadzinowski, J. Mazela, L. M. Graça, M. C. Machado, T. Rodrigues, H. Barros, A. K. Bonamy, M. Norman, E. Wilson, E. Boyle, E. S. Draper, B. N. Manktelow, A. C. Fenton, D. W. A. Milligan, J. Zeitlin, M. Bonet, A. Piedvache
Background: Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including neonatal characteristics and adherence to evidencebased practices in neonatal intensive care units (NICUs). Methods: 3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use. Results: PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]). Conclusion: PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended.


The research leading to these results received funding from the European Union's Seventh Framework Programme ([FP7/2007-2013]) under grant agreement n°259882. Additional funding in some countries: France (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, the National Institute of Cancer, and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future; and the PremUp Foundation); Poland (2012-2015 allocation of funds for international projects from the Polish Ministry of Science and Higher Education); Sweden (regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, and by the Department of Neonatal Medicine, Karolinska University Hospital). UK (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire & Humber regions). Funding for this open access publication was provided by the FP7 Post-Grant Open Access Pilot. [Last sentence added from correction]



PLoS ONE, 2017, 12(1): e0170234

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/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences


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We do not have IRB approval to share personal patient data outside of the European consortium. The EPICE project was approved by the French Advisory Committee on Use of Health Data in Medical Research (CCTIRS, N° 13.020 on 24/01/2013) and the French National Commission for Data Protection and Liberties (DR-2013-194, on 10/04/2013). Data will be made available upon request to all researchers who qualify for access to confidential data. The ethical and data protection approvals authorize the project to provide anonymized European data to members of each participating team after approval of each research study by the scientific committee and signature of data access and confidentiality agreements. The data sharing procedures are also regulated by the EPICE Consortium Agreement, which is the legal foundation for the EPICE scientific committee. For requests about the data, please contact Jennifer Zeitlin, Coordinator, EPICE study (;Correction 13 Feb 2017: Nuytten A, Behal H, Duhamel A, Jarreau PH, Mazela J, et al. (2017) Correction: Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study. PLOS ONE 12(2): e0172408. doi: 10.1371/journal.pone.0172408 Reads: "The following information is missing from the Funding section: Funding for this open access publication was provided by the FP7 Post-Grant Open Access Pilot."



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