title: [Variables determining the amount of care for very preterm neonates: the concept of medical stance].
abstract: OBJECTIVE
  To compare the amount of medical interventions on very preterm neonates (24-31 weeks of gestation) in two French university tertiary care centers, one of which is involved in a Neonatal Developmental Care program. A secondary objective is to assess whether this difference in medical interventions can be linked to a difference in mortality and morbidity rates.
  
  
  METHODS
  We prospectively included all very preterm neonates free from lethal malformation born live in these two centers between 2006 and 2010. These inclusion criteria were met by 1286 patients, for whom we compared the rate of five selected medical interventions: birth by caesarean section, chest intubation in the delivery room, surfactant therapy, pharmacological treatment of patent ductus arteriosus, and red blood cell transfusion.
  
  
  RESULTS
  The rates of the five medical interventions were systematically lower in the center that is involved in Neonatal Developmental Care. There was no significant difference in survival at discharge with no severe cerebral ultrasound scan abnormalities between the two centers. There were, however, significantly higher rates of bronchopulmonary dysplasia and nosocomial sepsis and longer hospital stays when the patients were not involved in a Neonatal Developmental Care program.
  
  
  CONCLUSIONS
  This benchmarking study shows that in France, in the first decade of the 21st century, there are as many ways to handle very preterm neonates as there are centers in which they are born. This brings to light the concept of medical stance, which is the general care approach prior to the treatment itself. This medical stance creates the overall framework for the staff's decision-making regarding neonate care. The different parameters structuring medical stance are discussed. Moreover, this study raises the problematic issue of the aftermath of benchmarking studies when the conclusion is an increase of morbidity in cases where procedure leads to more interventions.
authors.affiliation: Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France; Inserm-UMR S 953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, hôpital Cochin, 75014 Paris, France; UMPC université Paris 06, UMR S 953, 75005 Paris, France. Electronic address: antoine.burguet@chu-dijon.fr.
authors.forename: A
authors.initials: A
authors.lastname: Burguet
authors.affiliation: Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Menget
authors.affiliation: Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France.
authors.forename: A-C
authors.initials: AC
authors.lastname: Chary-Tardy
authors.affiliation: Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Savajols
authors.affiliation: Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Abed
authors.affiliation: Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France.
authors.forename: G
authors.initials: G
authors.lastname: Thiriez
mesh_terms: D019985:Benchmarking; D002585:Cesarean Section / Q000706:statistics & numerical data; D003696:Delivery Rooms; D004374:Ductus Arteriosus, Patent / Q000401:mortality / Q000628:therapy; D017707:Erythrocyte Transfusion; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000379:methods*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D016019:Survival Analysis; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D011663:Pulmonary Surfactants