Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study.
BMJ Open
; 10(6): e035075, 2020 06 22.
Article
in En
| MEDLINE
| ID: mdl-32571857
ABSTRACT
OBJECTIVES:
To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes.DESIGN:
Prospective cohort study, EPIPAGE-2.SETTING:
France, 2011.PARTICIPANTS:
53 (NICUs); 2135 VP neonates born at 27 to 31 weeks. OUTCOMEMEASURES:
Clusters of units, defined by the association of practices in five neonatal care domains - respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ).METHODS:
Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders.RESULTS:
Three clusters were identified Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24 hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies' characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95% CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95% CI 1.07 to 2.08).CONCLUSION:
In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Infant, Premature
/
Intensive Care Units, Neonatal
/
Outcome Assessment, Health Care
/
Infant, Very Low Birth Weight
/
Infant, Premature, Diseases
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Newborn
Country/Region as subject:
Europa
Language:
En
Journal:
BMJ Open
Year:
2020
Document type:
Article
Affiliation country:
France