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
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.
We identified four practices with a high level of evidence, which are related to mortality and short term morbidity. These 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.
58.3% of infants received all of the evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores and born on the day of maternal admission to hospital were less likely to receive evidence based care. If full evidence based care had been provided to all infants, we estimated there would be an 18% reduction in all deaths without an increase in severe morbidity. Comprehensive use of evidence-based practices in perinatal medicine could result in significant gains for very preterm infants, in terms of increased survival without severe morbidity.
See article here: http://bmj.com/cgi/content/full/bmj.i2976