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Wide variation in severe neonatal morbidity among very preterm infants in European regions.

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posted on 2018-01-26, 16:03 authored by Anna Karin Edstedt Bonamy, Jennifer Zeitlin, Aurélie Piedvache, Rolf F. Maier, Arno van Heijst, Heili Varendi, Bradley N. Manktelow, Alan Fenton, Jan Mazela, Marina Cuttini, Mikael Norman, Stavros Petrou, Patrick Van Reempts, Henrique Barros, Elizabeth S. Draper, Epice Research Group
OBJECTIVE: To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. DESIGN: Area-based cohort study of all births before 32 weeks of gestational age. SETTING: 16 regions in 11 European countries in 2011/2012. PATIENTS: Survivors to discharge from neonatal care (n=6422). MAIN OUTCOME MEASURES: Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. RESULTS: 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%-23.5%) and 13.8% including severe BPD (regional range 10.0%-23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%-18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50). CONCLUSION: Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.


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 is acknowledge 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 Prem Up 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 Humber regions).



Archives of Disease in Childhood - Fetal and Neonatal Edition, 2018

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


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Archives of Disease in Childhood - Fetal and Neonatal Edition


BMJ Publishing Group for Royal College of Paediatrics and Child Health, European Academy of Paediatrics





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Access to data in the EPICE cohort for researchers who are not members of the consortium is not currently possible, but EPICE is part of a H2020 project (RECAP, to develop a Platform for data sharing. Please contact the corresponding author for more information.



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