Two in five very preterm infants do not receive best practice evidence-based care to improve survival and reduce complications, new European research has found.
The latest findings come as part of the EPICE (Effective Perinatal Intensive Care in Europe) project, which is a geographically defined prospective study of all very preterm stillborn and liveborn infants from 22+0 weeks to 31+6 weeks of gestation, delivered in all public and private maternity hospitals in 19 regions in 11 European countries covering over 850,000 births annually: Belgium, Denmark, Estonia, France, Germany, Italy, the Netherlands, Poland, Portugal, Sweden and the United Kingdom.
Very preterm infants—those born before 32 weeks’ gestation—represent fewer than 2% of all births but up to half of infant deaths. For the infants that survive, the risks of cerebral palsy, visual and auditory deficits, cognitive impairments, psychiatric disorders, and behavioural problems are much higher than for children born at term. Although effective strategies exist to improve survival and reduce illness, it is not known how widely these are used in real life clinical settings.
The researchers therefore investigated the use of four evidence-based practices for the care of very preterm infants and measured their association with death and severe illness.
These four practices were: Delivery in a maternity unit with adequate on-site neonatal intensive care facilities; giving antenatal corticosteroids to reduce complications of prematurity; preventing hypothermia; and early treatment for breathing problems.
Using data from the EPICE project, 7,336 infants born between 24 to 31 weeks’ gestation were identified, all without serious congenital anomalies, and admitted to a specialised baby care unit between 2011 to 2012.
While the majority of infants received at least one of the evidence-based practices, only 58.3% of infants received all four practices for which they were eligible.
The chances of receiving full evidence-based care was lower for infants less than 26 weeks’ gestation, infants who were small for their gestational age, and infants with a low Apgar score (a quick test of a baby’s condition at birth).
According to the authors, if full evidence-based care had been provided to all infants, there would have been an 18% reduction in all deaths.
The study has its shortcomings, in that it is observational, so firm conclusions cannot be drawn about cause and effect. However, the authors say their findings “support the growing focus on bundling effective practices to improve processes of care and to achieve the best outcomes”.
“Maximising the number of very preterm infants who receive the complete set of these well proven practices could yield substantial gains in survival without increasing severe neonatal morbidity in survivors,” they concluded.