Very premature infants: Towards better care
- Date:
- July 5, 2016
- Source:
- INSERM (Institut national de la santé et de la recherche médicale)
- Summary:
- Born too soon, very premature infants are particularly vulnerable and need appropriate care. New research examines how medical practices based on scientific evidence are incorporated into the care of these neonates.
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Born too soon, very premature infants are particularly vulnerable and need appropriate care. The European project EPICE (Effective Perinatal Intensive Care in Europe) examines how medical practices based on scientific evidence are incorporated into the care of these neonates . The study, coordinated by Inserm and published in The British Medical Journal, highlights the underuse of four effective practices for improving their survival and long-term health, and estimates its impact on mortality and morbidity.
Very premature infants, born before 32 weeks of gestation, (8th month of pregnancy), represent 1-2% of all births. For these neonates, the risks of mortality and long-term neurological disorders are higher than for infants born at full term. It is essential to provide them with appropriate care in order to guarantee them better health.
The EPICE project created a population cohort in 2011, comprising all very premature infants from 19 regions in 11 countries of the European Union (Belgium, Denmark, Estonia, France, Germany, Italy, the Netherlands, Poland, Portugal, Switzerland and the United Kingdom). The goal of the project is to evaluate the "evidence-based medical practices" applied to these infants.
Evidence-based medicine, which takes research data, clinical expertise, and patient needs into consideration, enables health professionals to make care choices based on proven clinical efficacy. In this study, Jennifer Zeitlin, Inserm Research Director, studied four of these medical practices in particular, in order to measure their impact on neonatal mortality:
- - transfer of pregnant women to specialised centres designed to accommodate very premature infants,
- antenatal administration of corticosteroids (for maturation of the lungs),
- prevention of hypothermia,
- administration of surfactant (an essential substance for respiratory function that lines the pulmonary alveoli) within 2 hours after birth, or nasal positive pressure ventilation, for infants born before 28 weeks of gestation
While there was frequent use of each practice individually (75-89%), only 58% of very premature infants received all four recommended practices.
The study simulated two models to measure the impact of this inadequate care. If every infant had received all four recommended practices, mortality would have been reduced by 18%. These results demonstrate the importance of evidence-based medical care in improving the health of very premature infants.
Story Source:
Materials provided by INSERM (Institut national de la santé et de la recherche médicale). Note: Content may be edited for style and length.
Journal Reference:
- 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. Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort. BMJ, 2016; i2976 DOI: 10.1136/bmj.i2976
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