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Title: Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study.
Authors: Smith, Lucy K.
Blondel, Beatrice
Van Reempts, Patrick
Draper, Elizabeth S.
Manktelow, Bradley N.
Barros, Henrique
Cuttini, Marina
Zeitlin, Jennifer
EPICE Research Group
First Published: 23-Feb-2017
Publisher: BMJ Publishing Group for 1. Royal College of Paediatrics and Child Health 2. European Academy of Paediatrics
Citation: Archives of Disease in Childhood - Fetal and Neonatal Edition, 2017, doi: 10.1136/archdischild-2016-312100
Abstract: OBJECTIVE: To explore international variations in the management and survival of extremely low gestational age and birthweight births. DESIGN: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22(+0) and 25(+6) weeks gestation born in 2011-2012. MAIN OUTCOME MEASURES: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities). RESULTS: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision. CONCLUSIONS: Wide international variation exists in the management and survival of extremely preterm births at 22-24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines.
DOI Link: 10.1136/archdischild-2016-312100
eISSN: 1468-2052
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2017, The authors. Deposited with reference to the publisher’s archiving policy available on the SHERPA/RoMEO website.
Appears in Collections:Published Articles, Dept. of Health Sciences

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