The EPICE project

The EPICE project explored the use of evidence based practices for the care of very preterm infants in 19 regions from 11 EU Member States. Very preterm infants born before 32 weeks of gestation represent 1 to 2% of all births; these infants face higher risks of mortality and long-term neurodevelopmental impairment than infants born at term.

The EPICE project aimed to improve the survival and long-term health of preterm infants by ensuring that medical knowledge is translated into effective perinatal care. Promoting the use of evidence-based guidelines is a promising and cost-effective approach for improving of care and for optimizing health outcomes for these infants.

The EPICE “Effective Perinatal Intensive Care In Europe” project aimed to:

1. Build an empirical knowledge base about how scientific evidence is translated into health service provision in maternity and neonatal units by:

• • measuring the use of key medical interventions in clinical settings 
  • studying the factors associated with adoption of evidence based medical interventions
  • providing updated information on the effectiveness of medical practices

2. Identify catalysts for the uptake of evidence-based practices in units and on the regional level

3. Develop strategies to achieve change in the delivery of perinatal health care with the participation of front-line clinicians, researchers and policy makers

The EPICE project involved five studies using both quantitative and qualitative approaches to build a knowledge base about the use of evidence-based medical interventions for the care of very preterm babies at the regional, unit and patient level:

1. The cohort study measured use and determinants of 15-20 evidence-based interventions using validated indicators on all very preterm infants born in the participating regions. Data were also collected on clinical characteristics and patient outcomes. The EPICE cohort includes all stillbirths and live births between 22 and 31 weeks of gestation born in the 19 participating regions. Over 10 000 births, of which almost 8000 are live births, were included.

2. The unit study assessed policies, decision making and a wide range of different factors that might promote the use of evidence based practices in maternity and neonatal units. It included all neonatal and associated maternity units in the region that had a minimum of 10 very preterm amissions during the study period. Questionnaires on the units’ structural characteristics, policies and practices related to medical interventions and decision making were sent to medical teams in 2012, and completed by more than 130 maternity units and 153 neonatal units.

3. The qualitative studies included focus groups and in-depth interviews with medical professionals, with the aim to explore obstacles and facilitators for using evidence-based practices.

4. Case studies were done on 19 regions to describe and analyse how regional governance may affect the use of evidence-based practices.

5. A follow-up assessment at 2 years of age was carried out to obtain information on long term health outcomes in the children included in the cohort. Parents filled in a questionnaire on their children’s growth, motor and cognitive development and health. This follow-up enabled to assess effectiveness of different medical practices and policies by comparing outcomes in terms of survival free from major morbidities at 2 years of age.