Extremely preterm births: end-of-life decisions in European countries

To explore the influence of end-of-life decisions (EoL-D) on survival and mortality data in the light of differences reported among European countries.

We collected the published data of several epidemiological studies: Epicure, Epipage, Epibel and the Norwegian study performed in the UK, France, Belgium and Norway, respectively. The data concerning the Epibel and Norwegian studies are considered for a preliminary analysis, while the data relating to the Epicure and Epipage studies are compared based on the total published data. The statistical analysis was performed through the class of generalised linear models, and more specifically, through log-linear models. The data considered were the number of babies who died in neonatal intensive care units after active withdrawal classified according to the country and gestational age. RESULTS The probability of death after active withdrawal was significantly higher at 22 and 24 weeks' gestational age compared with week 25, when considering both countries (OR, 2.35 and 1.29, respectively). For the week 23(0)-->(6), the probability of death after active withdrawal was not significant; however, it is relevant when considering the OR (1.31). When considering the country, there was a higher probability of death after active withdrawal in France than in the UK, or alternatively, with the assumed baseline French parameter, in the UK, there was a lower probability of death after active withdrawal, with a significant OR=0.69. CONCLUSIONS The attitude towards EoL-D could in part explain the differences in survival data of extremely preterm infants and should be taken in mind when comparing international survival rates.