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Jones P, Marchand-Martin L, Desplanches T, Diguisto C, Fresson J, Goffinet F, Dauger S, Ancel PY, Morgan AS. Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001619. [PMID: 36645784 PMCID: PMC9756224 DOI: 10.1136/bmjpo-2022-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/29/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for. DESIGN Individual matched study nested within a prospective cohort. Each outborn infant was matched using GA and antenatal steroids with a maximum of four inborns. Conditional logistic regression was used to calculate ORs before being adjusted using maternal and birth characteristics. Analyses were carried out after multiple imputation for missing data. SETTING EPIPAGE-2 French national prospective cohort including births up to 34 weeks GA inclusive. PATIENTS Outborn and inborn control infants selected between 24 and 31 weeks GA were followed in the neonatal period and to 2 and 5.5 years. 3335 infants were eligible of whom all 498 outborns and 1235 inborn infants were included-equivalent to 2.5 inborns for each outborn. MAIN OUTCOME MEASURE Survival without moderate-to-severe neurodevelopmental impairment at 5.5 years. RESULTS Chorioamnionitis, pre-eclampsia, caesarian birth and small-for-dates were more frequent among inborns, and spontaneous labour and antepartum haemorrhage among outborns. There was no difference in the main outcome measure at 5.5 years of age (adjusted OR 1.09, 95% CI 0.82 to 1.44); sensitivity analyses suggested improved outcomes at lower GAs for inborns. CONCLUSION In this GA and steroid matched cohort, there was no difference in survival without moderate-to-severe neurodevelopmental impairment to 5.5 years of age between inborn and outborn very preterm children. This suggests steroids might be important in determining outcomes.
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Affiliation(s)
- Peter Jones
- SAMU de Paris, Necker-Enfants Malades Hospitals, Paris, France.,Paediatric Intensive Care, Hôpital Robert Debré, Robert-Debré Mother-Child University Hospital Mobile Service of Urgences and Reanimation, Paris, France
| | - Laetitia Marchand-Martin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France
| | - Thomas Desplanches
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon University Hospital, Dijon, France
| | - Caroline Diguisto
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Maternité Olympe de Gouges, CHRU Tours Pôle de Gynécologie Obstétrique Médecine fœtale et Reproduction, Tours, France
| | - Jeanne Fresson
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Population Health Office, DREES, Paris, France.,Department of Medical Information, University Hospital (CHRU) Nancy, Nancy, France
| | - François Goffinet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Department of Obstetrics and Gynaecology, Maternité Port-Royal, Association Publique - Hôpitaux de Paris, Paris, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert-Debré Mother-Child University Hospital, Paris, France
| | - Pierre-Yves Ancel
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France.,Clinical Investigation Center P1419, APHP, Paris, France
| | - Andrei Scott Morgan
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Université Paris Cité, INSERM, INRAE, Paris, France .,EGA Institute for Women's Health, UCL, London, UK.,Pôle Femmes-Parents-Enfants, Service de réanimation et médecine néonatale, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Lebreton E, Menguy C, Fresson J, Egorova NN, Crenn Hebert C, Zeitlin J. Measuring severe neonatal morbidity using hospital discharge data in France. Paediatr Perinat Epidemiol 2022; 36:190-201. [PMID: 34797588 DOI: 10.1111/ppe.12816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Measuring infant health at birth is key for surveillance and research in obstetrics and neonatology, but there is no international consensus on morbidity indicators. The Neonatal Adverse Outcome Indicator (NAOI) is a composite indicator, developed in Australia, which measures the burden of severe neonatal morbidity using hospital discharge data. OBJECTIVE To evaluate the applicability of the NAOI in France for surveillance and research. METHODS We constituted a cohort of live births ≥24 weeks' gestational age in Metropolitan France from 2014 to 2015 using hospital discharge, insurance claims and cause of death data. Outlier hospitals were identified using funnel plots of standardised morbidity ratios (SMR), and their coding patterns were assessed. We compared the NAOI and its component codes with published Australian and English data and estimated unadjusted and adjusted risk ratios for known risk factors for neonatal morbidity. RESULTS We included 1,459,123 births (511 hospitals). Twenty-eight hospitals had SMR above funnel plot control limits. Newborns with NAOI morbidities in these hospitals had lower mortality and shorter stays than in other hospitals. Amongst within-limit hospitals, NAOI prevalence was 4.8%, comparable to Australia (4.6%) and England (5.4%). Most individual components had a similar prevalence, with the exception of respiratory support, intravenous fluid procedures and infection. NAOI was lowest at 39 weeks (2.2%) with higher risks for maternal age ≥40 (relative risk [RR] 1.47, 95% confidence interval [CI] 1.42, 1.51), state medical insurance (RR 1.60, 95% CI 1.52, 1.68), male sex (RR 1.21, 95% CI 1.19, 1.23) and birthweight <3rd percentile (RR 4.60, 95% CI 4.51, 4.69). CONCLUSIONS The NAOI provides valuable information on population prevalence of severe neonatal morbidity and its risk factors. Whilst the prevalence was similar in high-income countries with comparable neonatal mortality levels, ensuring valid comparisons between countries and hospitals will require further work to harmonize coding procedures, especially for infection and respiratory morbidity.
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Affiliation(s)
- Elodie Lebreton
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Non Communicable Diseases and Trauma Division, Santé publique France, The National Public Health Agency, Saint-Maurice, France.,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France
| | - Claudie Menguy
- Non Communicable Diseases and Trauma Division, Santé publique France, The National Public Health Agency, Saint-Maurice, France.,Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France
| | - Jeanne Fresson
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Medical Information, Maternity of University Hospital - CHRU Nancy, Nancy, France
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Catherine Crenn Hebert
- Perinat-ARS-IDF, Regional Health Agency of Ile-de-France (ARS-IDF), Saint-Denis, France.,Maternity Unit, University Hospital (APHP), Hôpital Louis Mourier, Colombes, France
| | - Jennifer Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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