title: Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population-based studies in ten European regions.
abstract: OBJECTIVE
  To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions.
  
  
  METHODS
  Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals.
  
  
  METHODS
  70 hospitals in ten European regions.
  
  
  METHODS
  Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012).
  
  
  METHODS
  We used McNemar's Chi2test, paired t-tests and conditional logistic regression for comparisons over time.
  
  
  METHODS
  Reported policies, mortality and morbidity of EPTIs.
  
  
  RESULTS
  The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1).
  
  
  CONCLUSIONS
  European hospitals reporting changes in management policies experienced larger survival gains for EPTIs.
  
  
  CONCLUSIONS
  Changes in reported policies for management of extremely preterm births were related to mortality declines.
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: M
authors.initials: M
authors.lastname: Bonet
authors.affiliation: Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cuttini
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: A
authors.initials: A
authors.lastname: Piedvache
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Boyle
authors.affiliation: Service de Médecine et Réanimation néonatales de Port-Royal, DHU Risks in Pregnancy, Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, Paris, France.
authors.forename: P H
authors.initials: PH
authors.lastname: Jarreau
authors.affiliation: Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Kollée
authors.affiliation: Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany.
authors.forename: R F
authors.initials: RF
authors.lastname: Maier
authors.affiliation: University of Newcastle, Newcastle-upon-Tyne, UK.
authors.forename: Dwa
authors.initials: D
authors.lastname: Milligan
authors.affiliation: Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.|Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Van Reempts
authors.affiliation: Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.affiliation: EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: H
authors.initials: H
authors.lastname: Barros
authors.affiliation: Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Gadzinowki
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: E S
authors.initials: ES
authors.lastname: Draper
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: J
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000592:standards; D005060:Europe; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality; D016015:Logistic Models; D008297:Male; D000068101:Maternal-Child Health Services / Q000458:organization & administration* / Q000592:standards; D016134:Organizational Policy; D011247:Pregnancy; D047928:Premature Birth / Q000401:mortality*
keywords: Ethics; extremely preterm births; neonatal intensive care