title: Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study.
abstract: BACKGROUND
  Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including neonatal characteristics and adherence to evidence-based practices in neonatal intensive care units (NICUs).
  
  
  METHODS
  3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use.
  
  
  RESULTS
  PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]).
  
  
  CONCLUSIONS
  PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended.
authors.affiliation: Department of Neonatology, Jeanne de Flandre Hospital, Lille CHRU, Lille France.|Department of biostatistics, Univ. Lille, CHRU Lille, EA 2694-Lille, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nuytten
authors.affiliation: Department of biostatistics, Univ. Lille, CHRU Lille, EA 2694-Lille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Behal
authors.affiliation: Department of biostatistics, Univ. Lille, CHRU Lille, EA 2694-Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Université Paris V René Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France.
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Jarreau
authors.affiliation: Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Mazela
authors.affiliation: Newcastle University Newcastle upon Tyne, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Milligan
authors.affiliation: Children´s Hospital, University Hospital, University of Saarland, Homburg/Saar, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.affiliation: 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.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Piedvache
authors.affiliation: 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.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
authors.affiliation: Department of Neonatology, Jeanne de Flandre Hospital, Lille CHRU, Lille France.|Department of biostatistics, Univ. Lille, CHRU Lille, EA 2694-Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Truffert
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D015331:Cohort Studies; D005060:Europe; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal
chemical_list: D000305:Adrenal Cortex Hormones