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

Abstract:

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. METHODS:Standardized data collection for a geographically defined prospective cohort of VPTs (22+0-31+6 weeks gestation) across 16 regions in Europe. Crude and adjusted stillbirth and in-hospital mortality rates for VPT infants were calculated by time of death by using multinomial logistic regression models. RESULTS:The stillbirth and in-hospital mortality rate for VPTs was 27.7% (range, 19.9%-35.9% by region). Adjusting for maternal and pregnancy characteristics had little impact on the variation. The addition of infant characteristics reduced the variation of mortality rates by approximately one-fifth (4.8% to 3.9%). The SD for deaths <12 hours after birth was reduced by one-quarter, but did not change after risk adjustment for deaths ≥12 hours after birth. CONCLUSIONS:In terms of the regional variation in overall VPT mortality, over four-fifths of the variation could not be accounted for by maternal, pregnancy, and infant characteristics. Investigation of the timing of death showed that these characteristics only accounted for a small proportion of the variation in VPT deaths. These findings suggest that there may be an inequity in the quality of care provision and treatment of VPT infants across Europe.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Draper ES,Manktelow BN,Cuttini M,Maier RF,Fenton AC,Van Reempts P,Bonamy AK,Mazela J,Bᴓrch K,Koopman-Esseboom C,Varendi H,Barros H,Zeitlin JJ,EPICE Cohort.

doi

10.1542/peds.2016-1990

subject

Has Abstract

pub_date

2017-04-01 00:00:00

issue

4

eissn

0031-4005

issn

1098-4275

pii

peds.2016-1990

journal_volume

139

pub_type

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