Postnatal growth restriction and neurodevelopment at 5 years of age: a European extremely preterm birth cohort study.

Objective: To investigate whether extrauterine growth restriction (EUGR) during the neonatal hospitalisation by sex among extremely preterm (EPT) infants is associated with cerebral palsy (CP) and cognitive and motor abilities at 5 years of age.

Study Design: Population-based cohort of births <28 weeks of gestation with data from obstetric and neonatal records and parental questionnaires and clinical assessments at 5 years of age.

Setting: 11 European countries.

Association between postnatal growth and neurodevelopmental impairment by sex at 2 years of corrected age in a multi-national cohort of very preterm children.

Background & Aims: Extra-uterine growth restriction (EUGR) is common among very preterm (VPT) infants and has been associated with impaired neurodevelopment. Some research suggests that adverse effects of EUGR may be more severe in boys. We investigated EUGR and neurodevelopment at 2 years of corrected age (CA) by sex in a VPT birth cohort.

Variation in very preterm extrauterine growth in a European multicountry cohort.

Objective: Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures.

Design: Population-based observational study.

EPICE cohort: two-year neurodevelopmental outcomes after very preterm birth.

Objective: To determine whether the variation in neurodevelopmental disability rates between populations persists after adjustment for demographic, maternal and infant characteristics for an international very preterm (VPT) birth cohort using a standardised approach to neurodevelopmental assessment at 2 years of age.

Design: Prospective standardised cohort study.

Setting: 15 regions in 10 European countries.

Duration and Time Trends in Hospital Stay for Very Preterm Infants Differ Across European Regions.

Objectives: To compare duration and changes over time in length of hospital stay for very preterm and extremely preterm infants in 10 European regions.

Design: Two area-based cohort studies from the same regions in 2003 and 2011/2012.

Setting: Ten regions from nine European countries.

Wide variation in severe neonatal morbidity among very preterm infants in European regions.

Objective: To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.

Design: Area-based cohort study of all births before 32 weeks of gestational age.

Setting: 16 regions in 11 European countries in 2011/2012.

Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort.

Importance: Administration-to-birth intervals of antenatal corticosteroids (ANS) vary. The significance of this variation is unclear. Specifically, to our knowledge, the shortest effective administration-to-birth interval is unknown.

Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants.

Aim: This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references.

Methods: We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-2012, to estimate the prevalence of infants with SGA birthweights, namely those below the 10th percentile.

Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe.

Background And Objective: Stillbirth and in-hospital mortality rates associated with very preterm births (VPT) vary widely across Europe. International comparisons are complicated by a lack of standardized data collection and differences in definitions, registration, and reporting. This study aims to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death.

Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study.

Objective: To explore international variations in the management and survival of extremely low gestational age and birthweight births.

Design: Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22 and 25 weeks gestation born in 2011-2012.

Main Outcome Measures: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).

Patent Ductus Arteriosus Treatment in Very Preterm Infants: A European Population-Based Cohort Study (EPICE) on Variation and Outcomes.

Background: Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal medicine.

Objectives: The aim of this work was to study regional variations in PDA treatment in very preterm infants (≤31 weeks of gestation), its relation to differences in perinatal characteristics, and associations with bronchopulmonary dysplasia (BPD) and survival without major neonatal morbidity.

Methods: This was a population-based cohort study in 19 regions in 11 European countries conducted during 2011 and 2012.

Use of evidence based practices to improve survival without severe morbidity for very preterm infants: results from the EPICE population based cohort.

Objectives:  To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity.

Design:  Prospective multinational population based observational study.

Setting:  19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project.

Does the antenatal detection of fetal growth restriction (FGR) have a prognostic value for mortality and short-term morbidity for very preterm infants? Results from the MOSAIC cohort.

Objective: We investigated the impact of antenatal diagnosis of fetal growth restriction (FGR) on the risks of mortality and morbidity for very preterm infants given actual birthweight percentiles.

Methods: Data on 4608 live born infants 24-31 weeks of gestational age (GA) in 10 European regions in 2003 were used to compare in-hospital mortality, bronchopulmonary dysplasia (BPD) and severe neurological morbidity by birthweight percentiles and antenatal diagnosis of FGR. Other covariates were GA, sex, multiplicity, maternal complications, antenatal corticosteroids, birth in a level III center and region.

Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study.

Background: Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical prediction models for BPD.

Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort.

Objective: To assess the impact of being small for gestational age (SGA) on very preterm mortality and morbidity rates by using different birthweight percentile thresholds and whether these effects differ by the cause of the preterm birth.

Study Design: The study included singletons and twins alive at onset of labor between 24 and 31 weeks of gestation without congenital anomalies from the Models of Organising Access to Intensive Care for very preterm births very preterm cohort in 10 European regions in 2003 (n = 4525). Outcomes were mortality, intraventricular hemorrhage grade III and IV, cystic periventricular leukomalacia, and bronchopulmonary dysplasia (BPD).

Rates of bronchopulmonary dysplasia in very preterm neonates in Europe: results from the MOSAIC cohort.

Background: A considerable local variability in the rate of bronchopulmonary dysplasia (BPD) has been recorded previously.

Objectives: The objectives of the present study were to describe regional differences in the rate of BPD in very preterm neonates from a European population-based cohort and to further delineate risk factors.

Methods: 4,185 survivors to 36 weeks' postmenstrual age of 4,984 live-born infants born at 24+0-31+6 weeks' gestation in 2003 (the MOSAIC cohort) in 10 European regions were enrolled using predefined structured questionnaires.

Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data.

Background: Population and study design heterogeneity has confounded previous meta-analyses, leading to uncertainty about effectiveness and safety of elective high-frequency oscillatory ventilation (HFOV) in preterm infants. We assessed effectiveness of elective HFOV versus conventional ventilation in this group.

Methods: We did a systematic review and meta-analysis of individual patients' data from 3229 participants in ten randomised controlled trials, with the primary outcomes of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age, death or severe adverse neurological event, or any of these outcomes.

Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort.

Objectives: Advances in perinatal medicine increased survival after very preterm birth in all countries, but comparative population-based data on these births are not readily available. This analysis contrasts the rates and short-term outcome of live births before 32 weeks of gestation in 10 European regions.

Methods: The Models of Organizing Access to Intensive Care for Very Preterm Births (MOSAIC) study collected prospective data on all very preterm births in 10 European regions covering 494,463 total live births in 2003.

Screening for inter-hospital differences in cesarean section rates in low-risk deliveries using administrative data: an initiative to improve the quality of care.

Background: Rising national cesarean section rates (CSRs) and unexplained inter-hospital differences in CSRs, led national and international bodies to select CSR as a quality indicator. Using hospital discharge abstracts, we aimed to document in Belgium (1) inter-hospital differences in CSRs among low risk deliveries, (2) a national upward CSR trend, (3) lack of better neonatal outcomes in hospitals with high CSRs, and (4) possible under-use of CS.

Methods: We defined a population of low risk deliveries (singleton, vertex, full-term, live born, <4500 g, >2499 g).

Characteristics of neonatal units that care for very preterm infants in Europe: results from the MOSAIC study.

Objectives: We sought to compare guidelines for level III units in 10 European regions and analyze the characteristics of neonatal units that care for very preterm infants.

Methods: The MOSAIC (Models of Organising Access to Intensive Care for Very Preterm Births) project combined a prospective cohort study on all births between 22 and 31 completed weeks of gestation in 10 European regions and a survey of neonatal unit characteristics. Units that admitted > or = 5 infants at < 32 weeks of gestation were included in the analysis (N = 111).

The EPIBEL study: outcomes to discharge from hospital for extremely preterm infants in Belgium.

Objective: To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at
Methods: Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.

Results: A total of 525 infants were recorded.

Early use of high frequency ventilation in the premature neonate.

Unlabelled: This study evaluated whether the early use of high frequency ventilation (HFV) decreased the incidence of oxygen dependency at 36 weeks postconceptual age [chronic lung disease (CLD)] and improved developmental outcome. Neonates of less than 32 weeks gestational age needing ventilatory support for RDS who were admitted to a tertiary academic neonatal intensive care unit (NICU) within 6 h of birth were included in a prospective controlled clinical trial. With randomisation they were given either HFV (n=147) or conventional ventilation (CV) (n=153).