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Variation in follow-up for children born very preterm in Europe
Anna-Veera Seppänen1, Henrique Barros2, Elizabeth S Draper3
1Université de Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Paris, France.
Insights
European follow-up policies for very preterm infants vary significantly. Longer recommended follow-up duration correlates with higher reported rates of services at age five, especially for high-risk children.
Area of Science:
- Neonatal care
- Pediatric health services
- Public health policy
Background:
- Children born very preterm (<32 weeks gestation) have increased risks for neurodevelopmental and health issues.
- Post-discharge follow-up from neonatal intensive care is crucial for early detection and intervention.
- Data on follow-up policy approaches for these vulnerable children are limited.
Purpose of the Study:
- To investigate the characteristics of follow-up policies and programs for very preterm infants in 11 European countries (2011-2022).
- To explore the association between recommended follow-up duration and parent-reported follow-up rates at 5 years of age.
Main Methods:
- Utilized healthcare informant questionnaires and literature review across 11 European countries.
- Analyzed parent-reported follow-up data at 5 years from a 2011/12 cohort of very preterm births (N=3635).
Main Results:
- The number of countries with follow-up policies/programs increased from 6 to 11 between 2011/12 and 2022.
- Policies showed heterogeneity in eligibility, duration, and content.
- Longer recommended follow-up was linked to higher parent-reported follow-up rates at 5 years (42.1%-70.1% vs. <20%).
Conclusions:
- Significant variation exists in European follow-up policies for very preterm infants.
- Disparities in recommended follow-up duration contribute to cross-country differences in reported service utilization at 5 years of age.
Background:
Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse.
Methods:
We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635).
Results:
Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks' gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations.
Conclusions:
Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age.
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