World Prematurity Day: Nov. 17

This meeting organised in Paris from the 25th to the 27th of October, will be the opportunity to mark the end of inclusions for a cohort of over 8000 very preterm infants and to provide feedback on preliminary results of the project, launched in 2011.

Changing practices in obstetric and neonatal units

The EPICE project, set up 18 months ago, collects data from 19 European regions in order to identify the factors that promote the use of evidence-based medicine in the care of very preterm infants.

"The need to set up a European research project arose from the observation that mortality and morbidity rates for very preterm infants can vary by a factor greater than two between European regions", states Jennifer Zeitlin, coordinator of the EPICE project and Researcher at Inserm (Unit 953 "Epidemiological Research Unit on Perinatal Health and Women's and Children's Health").

Very preterm infants born before 32 weeks of gestation (the 8th month of pregnancy) represent between 1 and 2% of all births. They have a higher risk of mortality and long term neurological and developmental impairments than full term infants.

The EPICE project thus aims to improve the survival and long-term health of these children by ensuring that medical knowledge is translated into effective care. The project results will provide scientific knowledge on which to base intervention strategies to improve the use of evidence based medicine. It will also build a methodological and conceptual framework for future scientific work on the effectiveness of intervention strategies.

Promoting evidence-based medicine

The development of evidence-based clinical-practice guidelines is one of the most promising and cost-effective tools for improving the quality of care The EPICE project researchers are studying a large range of interventions, in order to identify the factors that promote their dissemination in everyday clinical practice. "The aim is to learn from the experiences of high performing neonatal units in Europe and to use what we learn to improve the care offered to very preterm infants" explains Jennifer Zeitlin.

19 medical interventions have been selected based on their clinical importance, the solidity of the evidence base and the feasibility of collecting data. These interventions concern such aspects as:

• The use of antenatal corticosteroids to promote lung maturation prior to a very preterm delivery,
• The transfer of pregnant women before delivery to specialised centres with a neonatal intensive care unit (level III units),
• The restriction of post-natal corticosteroid use,
• Promotion of breastfeeding.

Since March 2011, two epidemiological studies have been running in parallel: the first is a cohort study of more than 8000 very preterm infants (between 180 and 1500 depending on the country); the second focuses on the maternity hospitals and neonatal units that care for these infants.

• The cohort study will provide data about the care of very preterm infants and their health from birth to discharge home. These data will be completed with information about health and development at 2 years of age by means of a questionnaire sent to the family.
• Questionnaires given to the medical teams of 261 maternity hospitals and neonatal units collect data on the characteristics of the units, their organization and protocols for use of selected medical interventions and procedures.

The project's multidisciplinary team has expertise in obstetrics, neonatal medicine, epidemiology and health services research. By grouping and reinforcing national research initiatives, this project enhances cooperation and excellence in Europe.