Published articles

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort
Jennifer Zeitlin, Bradley N Manktelow, Aurelie Piedvache, Marina Cuttini, Elaine Boyle, Arno van Heijst, Janusz Gadzinowski, Patrick Van Reempts, Lene Huusom, Tom Weber, Stephan Schmidt, Henrique Barros, Dominico Dillalo, Liis Toome, Mikael Norman, Beatrice Blondel, Mercedes Bonet, Elisabeth S Draper, Rolf F Maier, and the EPICE Research Group
BMJ (2016)

Evidence-based practices are shown to improve health outcomes in children born preterm in randomised trials, but their use and impact in routine clinical practice remain poorly understood. We studied the implementation of high-evidence practices to assess whether they constitute a lever for reducing mortality and morbidity in children born preterm.

Wide variation in severe neonatal morbidity among very preterm infants in European regions.
Edstedt Bonamy AK, Zeitlin J, Piedvache A, Maier RF, van Heijst A, Varendi H, Manktelow BN, Fenton A, Mazela J, Cuttini M, Norman M, Petrou S, Reempts PV, Barros H, Draper ES; Epice Research Group.
Arch Dis Child Fetal Neonatal Ed. (2018)

The study aim was to investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.

This is an Area-based cohort study of all births before 32 weeks of gestational age. The cohort is composed of 6422 survivors to discharge from neonatal care units from 16 regions in 11 European countries included in 2011/2012.

Cohort study from 11 European countries highlighted differences in the use and efficacy of hypothermia prevention strategies after very preterm birth.
Wilson E, Zeitlin J, Piedvache A, Misselwitz B, Christensson K, Maier RF, Norman M, Edstedt Bonamy AK; EPICE Research Group.
Acta Paediatr. (2018)

This study investigated the different strategies used in 11 European countries to prevent hypothermia, which continues to affect a large proportion of preterm births in the region.

We examined the association between the reported use of hypothermia prevention strategies in delivery rooms and body temperatures on admission to neonatal intensive care units (NICUs) in 5861 infants born at 22 + 0 to 31 +6 weeks of gestation. The use of plastic bags, wraps, caps, exothermic heat and mattresses was investigated.

The Type of Feeding at Discharge of Very Preterm Infants: Neonatal Intensive Care Units Policies and Practices Make a Difference
Rodrigues C, Severo M, Zeitlin J, Barros H, Portuguese EPICE (Effective Perinatal Intensive Care in Europe) Network.
Breastfeed Med. (2017)

The aim was to assess the influence of neonatal intensive care units (NICUs) on feeding practices at discharge of Portuguese very preterm infants.

We analyzed data from 580 very preterm infants (<32 gestational weeks) discharged home from NICUs of two Portuguese regions and enrolled during 2011-2012 in Effective Perinatal Intensive Care in Europe population-based cohort. Maternal and infant characteristics were abstracted from medical records, and heads of NICUs provided the units characteristics. Feeding at discharge was classified as exclusive formula, exclusive breast milk or mixed, and differences among NICUs were obtained by comparison with pooled geometric mean odds of all NICUs, using multinomial logistic regression. Median odds ratios (MOR) were calculated to quantify variability among NICUs using multilevel logistic regression.

Prevalence and duration of breast milk feeding in very preterm infants: A 3-year follow-up study and a systematic literature review
Rodrigues C, Teixeira R, Fonseca MJ, Zeitlin J, Barros H, Portuguese EPICE (Effective Perinatal Intensive Care in Europe) Network.
Paediatr Perinat Epidemiol. (2018)

The World Health Organization recommends exclusive breast milk feeding until 6 months and continuing up to 2 years of age; little is known about whether very preterm infants are fed in accordance with these recommendations. We aimed to describe the prevalence and duration of breast milk feeding in very preterm children and to systematically review internationally published data.

We evaluated breast milk feeding initiation and duration in very preterm children born in 2 Portuguese regions (2011-2012) enrolled in the EPICE cohort and followed-up to the age of 3 (n = 466). We searched PubMed from inception to January 2017 to identify original studies reporting the prevalence and/or duration of breast milk feeding in very preterm children.

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