Changes in care and outcome of very preterm babies in the Parisian region between 1998 and 2003.
OBJECTIVE
To assess evolution in the care and health of very preterm babies between 1998 and 2003 after implementation of a regionalisation policy in France.


METHODS
Comparison of two population-based cohorts.


METHODS
The Parisian region.


METHODS
All live births at 24-31 weeks of gestation in 1997 (EPIPAGE study, n=488) and in 2003 (MOSAIC study, n=580). Interventions Implementation of regionalised perinatal networks. Main outcome measures In-hospital mortality and morbidity, including intraventricular haemorrhage (IVH) grade III and IV, cystic periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD).


RESULTS
Over this period, babies born in level III units rose from 67% to 77% and use of antenatal corticosteroids, indicated deliveries and surfactant increased. In-hospital mortality and IVH grades III/IV declined, ORs of 0.66 (95% CI 0.46 to 0.95) and 0.27 (95% CI 0.15 to 0.47), respectively, while PVL and BPD stayed constant. The rate of very preterm babies discharged alive per 1000 total births increased by 18%, but declined for babies with severe brain lesions.


CONCLUSIONS
The authors found improvements in mortality and morbidity for very preterm babies and changes in their care over a 6-year period following reinforcement of regionalisation policies.
Zeitlin
Jennifer
J
INSERM U953, Hôpital Saint Vincent de Paul, 82 av. Denfert Rochereau, Paris. jennifer.zeitlin@inserm.fr
Ancel
Pierre-Yves
PY
Delmas
Dominique
D
Bréart
Gérard
G
Papiernik
Emile
E
D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends; D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007224:Infant Care / Q000379:methods / Q000458:organization & administration / Q000639:trends*; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D019102:Infant, Very Low Birth Weight; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D016896:Treatment Outcome