Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study. Issue 6 (22nd June 2020)

• Record Type: Journal Article
• Authors: Pierrat, Veronique; Burguet, Antoine; Marchand-Martin, Laetitia; Cambonie, Gilles; Coquelin, Anaëlle; Roze, JC; Durox, Melanie; Guillois, Bernard; Morgan, Andrei S; Kaminski, Monique
• Other Names: author non-byline.; Arnaud C author non-byline.; Burguet A author non-byline.; Caeymaex L author non-byline.; Cambonie G author non-byline.; Datin-Dorrière V author non-byline.; Gire C author non-byline.; Guillois B author non-byline.; Kuhn P author non-byline.; Mitha A author non-byline.; Pierrat V author non-byline.; Roze JC author non-byline.; Roué JM author non-byline.; Sizun J author non-byline.
• Is Part Of: BMJ open. Volume 10:Issue 6(2020)
• Publication Date: 2020-06-22
• Subjects: epidemiology -- neonatology -- developmental neurology & neurodisability; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-035075
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes. Design: Prospective cohort study, EPIPAGE-2. Setting: France, 2011. Participants: 53 (NICUs); 2135 VP neonates born at 27 to 31 weeks. Outcome measures: Clusters of units, defined by the association of practices in five neonatal care domains – respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ). Methods: Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders. Results: Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies' characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08). Conclusion: In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.