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Very premature infants: Towards better care

July 05, 2016

Born too soon, very premature infants are particularly vulnerable and need appropriate care. The European project EPICE (Effective Perinatal Intensive Care in Europe) examines how medical practices based on scientific evidence are incorporated into the care of these neonates . The study, coordinated by Inserm and published in The British Medical Journal, highlights the underuse of four effective practices for improving their survival and long-term health, and estimates its impact on mortality and morbidity.

Very premature infants, born before 32 weeks of gestation, (8th month of pregnancy), represent 1-2% of all births. For these neonates, the risks of mortality and long-term neurological disorders are higher than for infants born at full term. It is essential to provide them with appropriate care in order to guarantee them better health.

The EPICE project created a population cohort in 2011, comprising all very premature infants from 19 regions in 11 countries of the European Union (Belgium, Denmark, Estonia, France, Germany, Italy, the Netherlands, Poland, Portugal, Switzerland and the United Kingdom). The goal of the project is to evaluate the "evidence-based medical practices" applied to these infants.

Evidence-based medicine, which takes research data, clinical expertise, and patient needs into consideration, enables health professionals to make care choices based on proven clinical efficacy. In this study, Jennifer Zeitlin, Inserm Research Director, studied four of these medical practices in particular, in order to measure their impact on neonatal mortality:
    - transfer of pregnant women to specialised centres designed to accommodate very premature infants,

    - antenatal administration of corticosteroids (for maturation of the lungs),

    - prevention of hypothermia,

    - administration of surfactant (an essential substance for respiratory function that lines the pulmonary alveoli) within 2 hours after birth, or nasal positive pressure ventilation, for infants born before 28 weeks of gestation

While there was frequent use of each practice individually (75-89%), only 58% of very premature infants received all four recommended practices.

The study simulated two models to measure the impact of this inadequate care. If every infant had received all four recommended practices, mortality would have been reduced by 18%. These results demonstrate the importance of evidence-based medical care in improving the health of very premature infants.

EPICE http://www.epiceproject.eu

"Effective Perinatal Intensive Care in Europe: translating knowledge into evidence-based practice"


The EPICE project is dedicated to the medical care of very preterm infants born before 32 weeks of gestation, in eleven European countries. The aim of the project is to assess practices in order to improve health care for this population of high risk babies.

The EPICE project was launched in 2011 and has been supported by the European Union (FP7) for five years. It is coordinated by Inserm, just like 27 other European "health" projects. The project involves 12 partners and 6 associate partners, based in 11 European countries.

The 12 partners:

Inserm (coordinator), France

SPE, Belgium

Hvidore Hospital, Denmark

Universitas Tartuensis, Estonia

Philipps Universität Marburg, Germany

Bambino Gesu Ospedale Pediatrico, Italy

Laziosanita Agenzia Di Sanita Pubblica, Italy

Radboud University Nijmegen Medical Centre, the Netherlands

Poznan University of Medical Sciences, Poland

U.Porto, Portugal

University of Leicester, United Kingdom

Karolinska Institutet, Sweden

EPICE in France

The EPICE project in France is part of a national study entitled EPIPAGE 2 (an epidemiological study on very preterm babies). It is a cohort study of very preterm infants, launched in 2011 in the 22 regions of mainland France and the French overseas departments. The study will monitor over 6000 premature children up to the age of 11 to 12. Three regions in France: Ile-de-France, Nord-Pas-de-Calais and Bourgogne participate in EPICE project.

The EPIPAGE 2 project is managed by the Inserm unit 953 ("Epidemiological research into perinatal health and the health of women and infants"), in collaboration with team 2, from UMRS 1027, directed by Dr Catherine Arnaud (Perinatal epidemiology, handicap of child and health of adolescents.

For further information on this study: http://www.epipage2.inserm.fr (Head of studies: Pierre-Yves Ancel, Inserm U953)
-end-
Sources

Use of evidence-based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population-based cohort

J Zeitlin1, BN Manktelow2, A Piedvache3, M Cuttini4, E Boyle MD5, A Van Heijst MD PhD6, J Gadzinowski7, P Van Reempts8, L Huusom9, T Weber10, S Schmidt11, H Barros12, L Toome13, M Norman14, B Blondel15, M Bonet16, ES Draper17, RF Maier18 and the EPICE Research Group

1. Senior researcher, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France

2. Senior Lecturer in Medical Statistics, Department of Health Sciences, University of Leicester, Leicester, LE1 6TP, UK

3. Statistician, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France

4. Perinatal Epidemiologist, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome Italy

5. Senior Lecturer in Neonatal Medicine, Department of Health Sciences, University of Leicester, Leicester, LE1 6TP, UK

6. Director, Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands

7. Professor and Chairman of Department, Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland

8. Professor of Paediatrics and Chairman of Department, Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp and Study Centre for Perinatal Epidemiology Flanders, Brussels , Belgium

9. Consultant Obstetrician and Gynaecologists, Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark

10. Consultant Obstetrician and Gynaecologists, Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark

11. Professor of Obstetrics, Department of Obstetrics, University Hospital, Philipps University, Marburg, D-35043, Germany

12. Professor of Epidemiology, EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal

13. Head of Unit of Neonates and Infants. Tallinn Children's Hospital, Tallinn, Estonia; Researcher, University of Tartu, Tartu, Estonia

14. Professor of Pediatrics and Neonatal Medicine, Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet; and Department of Neonatal Medicine, Karolinska University Hospital, SE 14186 Stockholm, Sweden

15. Senior researcher, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France

16. Researcher, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France

17. Professor of Perinatal and Paediatric Epidemiology, Department of Health Sciences, University of Leicester, Leicester, LE1 6TP, UK

18. Director of the Children´s Hospital and Chairman for Paediatrics, Children´s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany

BMJ, BMJ 2016; July 5th 2016, 354:i2976 doi:10.1136/bmj.i2976

Investigator contact

Jennifer Zeitlin
Inserm Unit 1153, Sorbonne Paris Cité Research Center in Epidemiology and Biostatistics (CRESS)
Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé)
Tel.: +33 1 42 34 55 77
Email: Jennifer.zeitlin@inserm.fr

INSERM (Institut national de la santé et de la recherche médicale)

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