Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Andrei Morgan 1, 2, 3, * Laurence Foix L'helias 1, 4, 5, 6 Caroline Diguisto 1, 7, 8 Laetitia Marchand-Martin 1 Monique Kaminski 1 Babak Khoshnood 1 Jennifer Zeitlin 1 Gérard Bréart 1 Xavier Durrmeyer 1, 9 François Goffinet 1, 10 Pierre-Yves Ancel 1, 11
* Corresponding author
1 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique
UPD5 - Université Paris Descartes - Paris 5, CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
2 Institute for Womens’ Health [London, UK]
3 SAMU 93 - SMUR Pédiatrique [CHI André Gregoire, Montreuil]
4 UPMC - Université Pierre et Marie Curie - Paris 6
5 Sorbonne Universités
6 Service de néonatologie [CHU Trousseau]
7 Maternité Olympe de Gouges [CHRU Tours]
8 Université Francois Rabelais [Tours]
9 Clinical Research Center - Service de Médecine Néonatale [CHI Créteil]
10 Maternité Port-Royal [CHU Cochin]
11 CIC 1419 - CIC - Mère Enfant Necker Cochin Paris Centre
Abstract : Background: Emerging evidence suggests intensity of perinatal care influences survival for extremely preterm babies. We evaluated the effect of differences in perinatal care intensity between centres on sensorimotor morbidity at 2 years of age. We hypothesised that hospitals with a higher intensity of perinatal care would have improved survival without increased disability. Methods: Foetuses alive at maternal admission to a level 3 hospital in France in 2011, subsequently delivered between 22 and 26 weeks gestational age (GA) and included in the EPIPAGE-2 national prospective observational cohort study formed the baseline population. Level of intensity of perinatal care was assigned according to hospital of birth, categorised into three groups using 'perinatal intensity' ratios (ratio of 24-25 weeks GA babies admitted to neonatal intensive care to foetuses of the same GA alive at maternal admission to hospital). Multiple imputation was used to account for missing data; hierarchical logistic regression accounting for births nested within centres was then performed. Results: One thousand one hundred twelve foetuses were included; 473 survived to 2 years of age (126 of 358 in low-intensity, 140 of 380 in medium-intensity and 207 of 374 in high-intensity hospitals). There were no differences in disability (adjusted odds ratios 0.93 (95% CI 0.28 to 3.04) and 1.04 (95% CI 0.34 to 3.14) in medium-and high-compared to low-intensity hospitals, respectively). Compared to low-intensity hospitals, survival without sensorimotor disability was increased in the population of foetuses alive at maternal admission to hospital and in live-born babies, but there were no differences when considering only babies admitted to NICU or survivors. Conclusions: No difference in sensorimotor outcome for survivors of extremely preterm birth at 2 years of age was found according to the intensity of perinatal care provision. Active management of periviable births was associated with increased survival without sensorimotor disability.
Keywords : Neonate Cohort study Vital status Epidemiology Neonatal Extreme prematurity Newborn Perinatal intensity Activity Obstetric
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Andrei Morgan, Laurence Foix L'helias, Caroline Diguisto, Laetitia Marchand-Martin, Monique Kaminski, et al.. Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study. BMC Medicine, BioMed Central, 2018, 16 (1), pp.227. ⟨10.1186/s12916-018-1206-4⟩. ⟨inserm-02148742⟩

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