Changes in care and outcome of very preterm babies in the Parisian region between 1998 and 2003
- Emile Papiernik (emile.papiernik{at}wanadoo.fr)
- Université Paris V Réné Descartes et Maternité de Port-Royal, Assistance-Publique Hôpitaux de Paris, France
- Published Online First 23 April 2009
Abstract
Objective: To assess evolutions in the care and health of very preterm babies between 1998 and 2003 after implementation of a regionalisation policy in France.
Design: Comparison of two population-based cohorts.
Setting: The Parisian region.
Patients: All live births 24 to 31 weeks of gestation in 1997 (EPIPAGE study, N=488) and 2003 (MOSAIC study, N=580).
Interventions: Implementation of regionalised perinatal networks.
Main outcome measures: In-hospital mortality and morbidity, including intraventricular haemorrhage (IVH) grade III and IV, cystic periventricular leukomalacia (PVL) and bronchopulmonary dysplasia (BPD).
Results: Over this period, babies born in level III units rose from 67 to 77% and use of antenatal corticosteroids, indicated deliveries and surfactant increased. In-hospital mortality and intraventricular haemorrhage grades III/IV declined, ORs of 0.66 (95% CI: 0.46-0.95) and 0.27 (95% CI: 0.15-0.47) respectively, while periventricular leukomalacia and bronchopulmonary dysplasia stayed constant. The rate of very preterm babies discharged alive per 1000 total births increased by 18%, but declined for babies with severe brain lesions.
Conclusions: We found improvements in mortality and morbidity for very preterm babies and changes in their care over a 6 year period following reinforcement of regionalisation policies.
