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Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the
Andrei S Morgan1,2,3, Laurence Foix L'Helias4,5,6, Caroline Diguisto4,7,8
1INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Hôpital Tenon, Rue de la Chine, Paris, 75020, France. andrei.morgan@inserm.fr.
Insights
Higher intensity perinatal care did not improve sensorimotor outcomes for extremely preterm infants. However, active management of periviable births was linked to better survival without disability.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Perinatal care intensity may impact survival and outcomes for extremely preterm infants.
- Variations in care intensity between centers are a key consideration.
- Previous hypotheses suggested higher intensity care would improve survival without increasing disability.
Purpose of the Study:
- To evaluate the effect of varying perinatal care intensity on sensorimotor morbidity at 2 years of age in extremely preterm infants.
- To determine if hospitals with higher perinatal care intensity show improved survival without increased disability.
- To analyze outcomes based on categorized levels of perinatal care intensity.
Main Methods:
- Analysis of the EPIPAGE-2 national prospective observational cohort study data (France, 2011).
- Inclusion of fetuses alive at maternal admission, delivered between 22-26 weeks gestational age.
- Categorization of hospital care intensity using 'perinatal intensity' ratios; statistical analysis with hierarchical logistic regression and multiple imputation.
Main Results:
- 1,112 fetuses were included; 473 survived to 2 years.
- No significant differences in sensorimotor disability were found across low, medium, and high perinatal care intensity groups.
- Survival without sensorimotor disability increased in the overall population and live-born babies compared to low-intensity hospitals, but not for NICU admissions or survivors alone.
Conclusions:
- No difference in sensorimotor outcomes for extremely preterm survivors at 2 years based on perinatal care intensity.
- Active management of periviable births demonstrated an association with increased survival without sensorimotor disability.
Background:
Emerging evidence suggests intensity of perinatal care influences survival for extremely preterm babies. We evaluated the effect of differences in perinatal care intensity between centres on sensorimotor morbidity at 2 years of age. We hypothesised that hospitals with a higher intensity of perinatal care would have improved survival without increased disability.
Methods:
Foetuses alive at maternal admission to a level 3 hospital in France in 2011, subsequently delivered between 22 and 26 weeks gestational age (GA) and included in the EPIPAGE-2 national prospective observational cohort study formed the baseline population. Level of intensity of perinatal care was assigned according to hospital of birth, categorised into three groups using 'perinatal intensity' ratios (ratio of 24-25 weeks GA babies admitted to neonatal intensive care to foetuses of the same GA alive at maternal admission to hospital). Multiple imputation was used to account for missing data; hierarchical logistic regression accounting for births nested within centres was then performed.
Results:
One thousand one hundred twelve foetuses were included; 473 survived to 2 years of age (126 of 358 in low-intensity, 140 of 380 in medium-intensity and 207 of 374 in high-intensity hospitals). There were no differences in disability (adjusted odds ratios 0.93 (95% CI 0.28 to 3.04) and 1.04 (95% CI 0.34 to 3.14) in medium- and high- compared to low-intensity hospitals, respectively). Compared to low-intensity hospitals, survival without sensorimotor disability was increased in the population of foetuses alive at maternal admission to hospital and in live-born babies, but there were no differences when considering only babies admitted to NICU or survivors.
Conclusions:
No difference in sensorimotor outcome for survivors of extremely preterm birth at 2 years of age was found according to the intensity of perinatal care provision. Active management of periviable births was associated with increased survival without sensorimotor disability.
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