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Specialist health care services use in a European cohort of infants born very preterm.

journal contribution
posted on 2019-01-31, 14:20 authored by Anna‐Veera Seppänen, Florence Bodeau-Livinec, Elaine M. Boyle, Anna‐Karin Edstedt-Bonamy, Marina Cuttini, Liis Toome, Rolf F. Maier, Eva Cloet, Corine Koopman-Esseboom, Pernille Pedersen, Janusz Gadzinowski, Henrique Barros, Jennifer Zeitlin, Effective Perinatal Intensive Care in Europe (EPICE) research group
AIM: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.


The research received funding from the European Union's Seventh Framework Programme (FP7/2007‐2013) under grant agreement No 259882 and received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 633724. Additional funding is acknowledged from the following regions: 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 (Stockholm County Council [ALF‐project and Clinical Research Appointment] and by the Department of Neonatal Medicine, Karolinska University Hospital), UK (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire and the Humber regions). Anna‐Veera Seppänen has a doctoral contract funded by Sorbonne Université, Collège Doctoral, Paris, France.



Developmental Medicine and Child Neurology, 2018

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences


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Developmental Medicine and Child Neurology


Wiley for Mac Keith Press



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The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.



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