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Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study
L A A Kollée1, M Cuttini, D Delmas
1Department of Paediatrics, Children's Hospital, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. l.kollee@cukz.umcn.nl
Insights
Obstetric interventions for extremely preterm births vary significantly across European regions, impacting infant mortality and morbidity. Higher intervention levels at 24-25 weeks correlated with increased mortality and bronchopulmonary dysplasia in survivors.
Area of Science:
- Neonatalogy
- Perinatology
- Public Health
Background:
- Extremely preterm births (22-29 weeks gestation) present significant challenges.
- Variations in obstetric interventions may influence survival and short-term outcomes.
- Understanding regional differences in care is crucial for improving outcomes.
Purpose of the Study:
- To document obstetric intervention practices for extremely preterm births across ten European regions.
- To evaluate the association between the level of obstetric intervention and infant mortality and morbidity.
Main Methods:
- A prospective observational cohort study involving 4146 births from 22 to 29 weeks gestation in 2003.
- Data collected from ten European regions participating in the MOSAIC project.
- Interventions analyzed included antenatal corticosteroids, antenatal transfer, and caesarean section, with outcomes assessed by gestational age groups.
Main Results:
- Significant regional disparities were observed in obstetric interventions, particularly for births at 22-25 weeks gestation.
- Higher composite intervention scores at 24-25 weeks were associated with increased mortality.
- For survivors born at 24-25 weeks, higher intervention scores correlated with greater rates of bronchopulmonary dysplasia (BPD).
Conclusions:
- Substantial variations in obstetric interventions exist at the threshold of viability across European regions.
- These regional differences in practice are linked to infant outcomes, especially for births at 24-25 weeks gestation.
Objective:
To describe obstetric intervention for extremely preterm births in ten European regions and assess its impact on mortality and short term morbidity.
Design:
Prospective observational cohort study.
Setting:
Ten regions from nine countries participating in the 'Models of Organising Access to Intensive Care for Very Preterm Babies in Europe' (MOSAIC) project.
Population:
All births from 22 to 29 weeks of gestation (n = 4146) in 2003, excluding terminations of pregnancy.
Methods:
Comparison of three obstetric interventions (antenatal corticosteroids, antenatal transfer and caesarean section for fetal indication) rates at 22-23, 24-25 and 26-27 weeks to that at 28-29 weeks and the association of the level of intervention with pregnancy outcome.
Main Outcome Measures:
Use of antenatal corticosteroids, antenatal transfer and caesarean section by two-week gestational age groups as well as a composite score of these three interventions. Outcomes included stillbirth, in-hospital mortality and intraventricular haemorrhage (IVH) grades III and IV and/or periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD).
Results:
There were large differences between regions in interventions for births at 22-23 and 24-25 weeks. Differences were most pronounced at 24-25 weeks; in some regions these babies received the same care as babies of 28-29 weeks, whereas elsewhere levels of intervention were distinctly lower. Before 26 weeks and especially at 24-25 weeks, there was an association between the composite intervention score and mortality. No association was observed at 26-27 weeks. For survivors at 24-25 weeks, the intervention score was associated with higher rates of BPD, but not with IVH or PVL.
Conclusions:
There are large differences between European regions in obstetric practices at the lower limit of viability and these are related to outcome, especially at 24-25 weeks.
