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[Evidence versus experience in neonatal practice: the example of extremely premature infants]
M-O Marcoux1, S Denizot, G Dassieu
1Service de réanimation mixte et polyvalente, Hôpital des enfants, Toulouse, Hôpital des enfants, Toulouse, France. marcoux.mo@chu-toulouse.fr
Insights
Different ventilation and nutrition strategies exist in French neonatal intensive care units for extremely preterm infants. These variations impacted short-term mortality rates, highlighting the need for standardized approaches.
Area of Science:
- Neonatology
- Pediatric Critical Care
- Perinatal Medicine
Context:
- Extremely preterm infants (<28 weeks gestation) require specialized nutritional and ventilatory support.
- Variations in clinical practice may exist between neonatal intensive care units (NICUs).
- Understanding these variations is crucial for optimizing infant care and outcomes.
Purpose:
- To compare current nutritional and ventilation strategies in four French NICUs for extremely preterm infants.
- To evaluate whether differences in ventilatory and nutritional approaches affect short-term infant outcomes.
- To assess the consistency between review recommendations, local guidelines, and actual clinical practice.
Summary:
- A retrospective study analyzed 399 extremely preterm infants (gestational age <28 weeks) across four French NICUs (2005-2006).
- Significant differences in ventilatory and nutritional strategies were observed between the units.
- Despite strategy variations, incidences of necrotizing enterocolitis (NEC), severe intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL) were similar. However, mortality rates varied significantly (p<0.05).
Impact:
- Identifies significant variability in clinical practices for extremely preterm infant care across NICUs.
- Highlights that while some short-term morbidities were comparable, mortality rates differed, suggesting potential impact of specific strategies or unmeasured factors.
- Suggests the need for a national database to further investigate strategy-outcome relationships and long-term results.
Abstract:
We focused on current nutritional and ventilation strategies of extremely preterm infants and reviewed the evidence and the practical experience in four French neonatal intensive care units. The recommendations from reviews and the local clinical guidelines were compared and were overall in agreement. We wanted then to evaluate if different ventilatory and nutritional styles existed between four French intensive neonatal units, and if these approaches had an effect on short term outcomes. 399 infants delivered at a gestational age <28 weeks between January 2005 and December 2006 were retrospectively studied (unit I = 141, unit II = 97, unit III = 85, unit IV = 76). Data were collected from birth to discharge. The study groups were similar with regard to gestational age, birth weight, gender, prenatal steroids, rate of inborn. There were significant differences in ventilatory and nutritional strategies between the units. Incidence of NEC, IVH grade 3-4 and PVL were similar between the units. Mortality rate during the hospitalization stay was 14.9 %, 35.0 %, 29.4 % and 29 % (p<0.05). A national database would be useful to analyse differences in strategies and long term outcomes.
