Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe.
OBJECTIVE
Stillbirth and in-hospital mortality rates associated with very preterm births (VPT) vary widely across Europe. International comparisons are complicated by a lack of standardized data collection and differences in definitions, registration, and reporting. This study aims to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death.


METHODS
Standardized data collection for a geographically defined prospective cohort of VPTs (22+0-31+6weeks gestation) across 16 regions in Europe. Crude and adjusted stillbirth and in-hospital mortality rates for VPT infants were calculated by time of death by using multinomial logistic regression models.


RESULTS
The stillbirth and in-hospital mortality rate for VPTs was 27.7% (range, 19.9%-35.9% by region). Adjusting for maternal and pregnancy characteristics had little impact on the variation. The addition of infant characteristics reduced the variation of mortality rates by approximately one-fifth (4.8% to 3.9%). The SD for deaths <12 hours after birth was reduced by one-quarter, but did not change after risk adjustment for deaths ≥12 hours after birth.


CONCLUSIONS
In terms of the regional variation in overall VPT mortality, over four-fifths of the variation could not be accounted for by maternal, pregnancy, and infant characteristics. Investigation of the timing of death showed that these characteristics only accounted for a small proportion of the variation in VPT deaths. These findings suggest that there may be an inequity in the quality of care provision and treatment of VPT infants across Europe.
Department of Health Sciences, University of Leicester, Leicester, United Kingdom; msn@le.ac.uk.
Elizabeth S
ES
Draper
Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
Bradley N
BN
Manktelow
Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy.
Marina
M
Cuttini
Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany.
Rolf F
RF
Maier
Newcastle Neonatal Services, Royal Victoria Infirmary, Newcastle, United Kingdom.
Alan C
AC
Fenton
Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.|Flemish Study Centre for Perinatal Epidemiology, Brussels, Belgium.
Patrick
P
Van Reempts
Departments of Medicine Solna and.|Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Anna-Karin
AK
Bonamy
Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
Jan
J
Mazela
Department of Neonatology, Hvidovre University Hospital, Hvidovre, Denmark.
Klaus
K
Bᴓrch
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.
Corinne
C
Koopman-Esseboom
Department of Pediatrics, University of Tartu, Tartu University Hospital, Tartu, Estonia.
Heili
H
Varendi
EPIUnit Institute of Public Health, University of Porto, Porto, Portugal; and.
Henrique
H
Barros
INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.
Jennifer J
JJ
Zeitlin
D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D011446:Prospective Studies; D050497:Stillbirth / Q000453:epidemiology*