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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30
Alexandra Nuytten1,2, Hélène Behal2, Alain Duhamel2
1Department of Neonatology, Jeanne de Flandre Hospital, Lille CHRU, Lille France.
Insights
Postnatal corticosteroids are frequently used in Europe for preterm infants, despite risks. A clear policy in neonatal intensive care units (NICUs) can significantly reduce their use, improving infant outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Public Health
Background:
- Postnatal corticosteroids (PNC) were historically used for bronchopulmonary dysplasia in preterm infants.
- Concerns exist regarding increased risks of cerebral palsy and neurodevelopmental impairment associated with PNC.
- Variations in PNC use across European neonatal intensive care units (NICUs) necessitate investigation.
Purpose of the Study:
- To describe the utilization patterns of postnatal corticosteroids (PNC) in European NICUs.
- To identify neonatal characteristics and unit-level factors influencing PNC prescription.
- To evaluate the impact of adherence to evidence-based practices on PNC use.
Main Methods:
- Analysis of the EPICE cohort, including 3917 infants born between 24-29 weeks gestational age across 11 European countries.
- Logistic regression to determine predictors of PNC use and categorize infants by risk tertiles.
- Assessment of NICU adherence to European respiratory management recommendations and stated PNC reduction policies.
Main Results:
- PNC were prescribed to 13.9% of infants, with significant regional variation (3.1-49.4%).
- Independent predictors of PNC use included lower gestational age, small for gestational age, male sex, mechanical ventilation, and NSAID use for PDA.
- A stated NICU policy of reduced PNC use was associated with significantly lower prescription rates (OR 0.29).
Conclusions:
- Postnatal corticosteroid use in Europe is frequent and exhibits substantial unexplained regional variability.
- Neonatal characteristics alone do not fully explain prescribing patterns, highlighting the role of institutional practices.
- Implementing policies to reduce PNC use in NICUs is recommended and associated with decreased utilization.
Background:
Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including neonatal characteristics and adherence to evidence-based practices in neonatal intensive care units (NICUs).
Methods:
3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use.
Results:
PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]).
Conclusion:
PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended.
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