Study underscores importance of evidence-based medical care in improving health of neonates

University of Leicester involved in project into infant mortality and morbidity

Born too soon, very premature infants are particularly vulnerable and need appropriate care.

The European project EPICE (Effective Perinatal Intensive Care in Europe) examines how medical practices based on scientific evidence are incorporated into the care of these neonates.

The study, coordinated by Inserm and published in The British Medical Journal, highlights the underuse of four effective practices for improving their survival and long-term health, and estimates its impact on mortality and morbidity.

Very premature infants, born before 32 weeks of gestation, (8th month of pregnancy), represent 1-2% of all births. For these neonates, the risks of mortality and long-term neurological disorders are higher than for infants born at full term. It is essential to provide them with appropriate care in order to guarantee them better health.

The EPICE project created a population cohort in 2011, comprising all very premature infants from 19 regions in 11 countries of the European Union (Belgium, Denmark, Estonia, France, Germany, Italy, the Netherlands, Poland, Portugal, Sweden and the United Kingdom). The goal of the project is to evaluate the "evidence-based medical practices" applied to these infants.

Evidence-based medicine, which takes research data, clinical expertise, and patient needs into consideration, enables health professionals to make care choices based on proven clinical efficacy. In this study, Jennifer Zeitlin, Inserm Research Director, studied four of these medical practices in particular, in order to measure their impact on neonatal mortality:

- transfer of pregnant women to specialised centres designed to accommodate very premature infants

- antenatal administration of corticosteroids (for maturation of the lungs),

- prevention of hypothermia,

- administration of surfactant (an essential substance for respiratory function that lines the pulmonary alveoli) within 2 hours after birth, or nasal positive pressure ventilation, for infants born before 28 weeks of gestation

While there was frequent use of each practice individually (75-89%), only 58% of very premature infants received all four recommended practices.

Professor Elizabeth Draper from the University of Leicester Department of Health Sciences and The Infant Mortality and Morbidity Studies (TIMMS) group, who led the UK arm of the study, said: "From a UK perspective this is very positive in that the use of evidence-based practice in the 3 regions in the study was higher than the overall average for this European collaboration with 75% of premature infants in East Midlands and Yorkshire health regions receiving all four recommended practices."

The study simulated two models to measure the impact of this inadequate care. If every infant had received all four recommended practices, mortality would have been reduced by 18%. These results demonstrate the importance of evidence-based medical care in improving the health of very premature infants.