Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study
Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including ne...
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| Veröffentlicht in: | PloS one 2017-01, Vol.12 (1), p.e0170234-e0170234 |
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| creator | Nuytten, Alexandra Behal, Hélène Duhamel, Alain Jarreau, Pierre-Henri Mazela, Jan Milligan, David Gortner, Ludwig Piedvache, Aurélie Zeitlin, Jennifer Truffert, Patrick |
| description | Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including neonatal characteristics and adherence to evidence-based practices in neonatal intensive care units (NICUs).
3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use.
PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]).
PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended. |
| doi_str_mv | 10.1371/journal.pone.0170234 |
| format | Article |
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3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use.
PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]).
PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0170234</identifier><identifier>PMID: 28114369</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adrenal Cortex Hormones - administration & dosage ; Age ; Anti-inflammatory agents ; Biology and Life Sciences ; Bronchopulmonary dysplasia ; Cerebral palsy ; Cohort analysis ; Cohort Studies ; Corticoids ; Corticosteroid drugs ; Corticosteroids ; Data collection ; Determinants ; Dosage and administration ; Drug therapy ; Drugs ; Dysplasia ; Epidemiology ; Europe ; Evidence-based practice ; Gestational Age ; Health aspects ; Hospitals ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infants ; Inflammation ; Intensive care ; Intensive Care Units ; Intensive Care Units, Neonatal ; Life Sciences ; Lung diseases ; Management ; Mechanical ventilation ; Medicine and health sciences ; Mortality ; Neonatal ; Neonates ; Neurodevelopmental disorders ; Newborn ; Newborn babies ; Nonsteroidal anti-inflammatory drugs ; Paralysis ; Pediatrics ; People and Places ; Physical Sciences ; Population studies ; Population-based studies ; Postnatal care ; Premature ; Premature birth ; Premature infants ; Prevention ; Questionnaires ; Regression analysis ; Respiratory distress syndrome ; Risk ; Small for gestational age ; Statistical analysis ; Surfactants ; Ventilation</subject><ispartof>PloS one, 2017-01, Vol.12 (1), p.e0170234-e0170234</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Nuytten et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Attribution</rights><rights>2017 Nuytten et al 2017 Nuytten et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c759t-5b2d3ab506b31df451454ca7812bcdc648434a63d059fe526659741c8696fcd23</citedby><cites>FETCH-LOGICAL-c759t-5b2d3ab506b31df451454ca7812bcdc648434a63d059fe526659741c8696fcd23</cites><orcidid>0000-0002-9568-2969</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256868/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256868/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28114369$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-lille.fr/hal-02530743$$DView record in HAL$$Hfree_for_read</backlink></links><search><contributor>Simeoni, Umberto</contributor><creatorcontrib>Nuytten, Alexandra</creatorcontrib><creatorcontrib>Behal, Hélène</creatorcontrib><creatorcontrib>Duhamel, Alain</creatorcontrib><creatorcontrib>Jarreau, Pierre-Henri</creatorcontrib><creatorcontrib>Mazela, Jan</creatorcontrib><creatorcontrib>Milligan, David</creatorcontrib><creatorcontrib>Gortner, Ludwig</creatorcontrib><creatorcontrib>Piedvache, Aurélie</creatorcontrib><creatorcontrib>Zeitlin, Jennifer</creatorcontrib><creatorcontrib>Truffert, Patrick</creatorcontrib><creatorcontrib>EPICE (Effective Perinatal Intensive Care in Europe) Research Group</creatorcontrib><creatorcontrib>On behalf of the EPICE (Effective Perinatal Intensive Care in Europe) Research Group</creatorcontrib><title>Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including neonatal characteristics and adherence to evidence-based practices in neonatal intensive care units (NICUs).
3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use.
PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]).
PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended.</description><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Age</subject><subject>Anti-inflammatory agents</subject><subject>Biology and Life Sciences</subject><subject>Bronchopulmonary dysplasia</subject><subject>Cerebral palsy</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Corticoids</subject><subject>Corticosteroid drugs</subject><subject>Corticosteroids</subject><subject>Data collection</subject><subject>Determinants</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Dysplasia</subject><subject>Epidemiology</subject><subject>Europe</subject><subject>Evidence-based practice</subject><subject>Gestational Age</subject><subject>Health aspects</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infant, Premature</subject><subject>Infants</subject><subject>Inflammation</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Intensive Care Units, Neonatal</subject><subject>Life Sciences</subject><subject>Lung diseases</subject><subject>Management</subject><subject>Mechanical ventilation</subject><subject>Medicine and health sciences</subject><subject>Mortality</subject><subject>Neonatal</subject><subject>Neonates</subject><subject>Neurodevelopmental disorders</subject><subject>Newborn</subject><subject>Newborn babies</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Paralysis</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Postnatal care</subject><subject>Premature</subject><subject>Premature birth</subject><subject>Premature infants</subject><subject>Prevention</subject><subject>Questionnaires</subject><subject>Regression analysis</subject><subject>Respiratory distress syndrome</subject><subject>Risk</subject><subject>Small for gestational age</subject><subject>Statistical analysis</subject><subject>Surfactants</subject><subject>Ventilation</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99u0zAUxiMEYmPwBggsISF20eL_SW6QujK2SRObGINLy7Gd1iO1i-0M9kI8J87aTeu0iykXSU5-33fizz5F8RrBMSIl-njh--BkN156Z8YQlRAT-qTYRjXBI44heXrneat4EeMFhIxUnD8vtnCFECW83i7-7V9abZwyoz0ZjQZfjXcyyQ6cO5vAaZAqWWUikE6DzyaZsLBOuhSBb8Gpj2kFT33IWH41wVs9Oo8GWJfV1wKwZ0OaR9CYzv8BBIKfxvyK4GAyMPt98EszBpPstuw7max361-Z-nm2BWep11cvi2et7KJ5tb7vFOdf9r9PD0fHJwdH08nxSJWsTiPWYE1kwyBvCNItZYgyqmRZIdworTitKKGSEw1Z3RqGOWd1SZGqeM1bpTHZKd6ufJedj2IdcRSo4gjWGJV1Jo5WhPbyQiyDXchwJby04rrgw0zIIYzOiIoiXCJNsZaU4po1DFVS8ZJLVCNI2uz1ad2tbxZGK-NSkN2G6eYXZ-di5i8Fw4xXvMoGuyuD-T3Z4eRYDDWIGYElJZcosx_WzYL_3ZuYxMJGZbpOOuP76zVWBFVVVjwCRRwRQobA3t1DHw5tTc1kzsW61uflqMFUTGiZe0LCeKbGD1D50maRT5czrc31DcHuhiAzyfxNM9nHKI7Ovj2ePfmxyb6_w86N7PL59V0_HM64CdIVqIKPMZj2dhMQFMOU3qQhhikV6ynNsjd39_1WdDOW5D_WczUR</recordid><startdate>20170123</startdate><enddate>20170123</enddate><creator>Nuytten, 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A Population-Based Cohort Study</title><author>Nuytten, Alexandra ; Behal, Hélène ; Duhamel, Alain ; Jarreau, Pierre-Henri ; Mazela, Jan ; Milligan, David ; Gortner, Ludwig ; Piedvache, Aurélie ; Zeitlin, Jennifer ; Truffert, Patrick</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c759t-5b2d3ab506b31df451454ca7812bcdc648434a63d059fe526659741c8696fcd23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Age</topic><topic>Anti-inflammatory agents</topic><topic>Biology and Life Sciences</topic><topic>Bronchopulmonary dysplasia</topic><topic>Cerebral palsy</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Corticoids</topic><topic>Corticosteroid drugs</topic><topic>Corticosteroids</topic><topic>Data collection</topic><topic>Determinants</topic><topic>Dosage and administration</topic><topic>Drug 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Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nuytten, Alexandra</au><au>Behal, Hélène</au><au>Duhamel, Alain</au><au>Jarreau, Pierre-Henri</au><au>Mazela, Jan</au><au>Milligan, David</au><au>Gortner, Ludwig</au><au>Piedvache, Aurélie</au><au>Zeitlin, Jennifer</au><au>Truffert, Patrick</au><au>Simeoni, Umberto</au><aucorp>EPICE (Effective Perinatal Intensive Care in Europe) Research Group</aucorp><aucorp>On behalf of the EPICE (Effective Perinatal Intensive Care in Europe) Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-01-23</date><risdate>2017</risdate><volume>12</volume><issue>1</issue><spage>e0170234</spage><epage>e0170234</epage><pages>e0170234-e0170234</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Postnatal corticosteroids (PNC) were widely used to treat and prevent bronchopulmonary dysplasia in preterm infants until studies showed increased risk of cerebral palsy and neurodevelopmental impairment. We aimed to describe PNC use in Europe and evaluate the determinants of their use, including neonatal characteristics and adherence to evidence-based practices in neonatal intensive care units (NICUs).
3917/4096 (95,6%) infants born between 24 and 29 weeks gestational age in 19 regions of 11 European countries of the EPICE cohort we included. We examined neonatal characteristics associated with PNC use. The cohort was divided by tertiles of probability of PNC use determined by logistic regression analysis. We also evaluated the impact of the neonatal unit's reported adherence to European recommendations for respiratory management and a stated policy of reduced PNC use.
PNC were prescribed for 545/3917 (13.9%) infants (regional range 3.1-49.4%) and for 29.7% of infants in the highest risk tertile (regional range 5.4-72.4%). After adjustment, independent predictors of PNC use were a low gestational age, small for gestational age, male sex, mechanical ventilation, use of non-steroidal anti-inflammatory drugs to treat persistent ductus arteriosus and region. A stated NICU policy reduced PNC use (odds ratio 0.29 [95% CI 0.17; 0.50]).
PNC are frequently used in Europe, but with wide regional variation that was unexplained by neonatal characteristics. Even for infants at highest risk for PNC use, some regions only rarely prescribed PNC. A stated policy of reduced PNC use was associated with observed practice and is recommended.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28114369</pmid><doi>10.1371/journal.pone.0170234</doi><tpages>e0170234</tpages><orcidid>https://orcid.org/0000-0002-9568-2969</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-01, Vol.12 (1), p.e0170234-e0170234 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1861092179 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adrenal Cortex Hormones - administration & dosage Age Anti-inflammatory agents Biology and Life Sciences Bronchopulmonary dysplasia Cerebral palsy Cohort analysis Cohort Studies Corticoids Corticosteroid drugs Corticosteroids Data collection Determinants Dosage and administration Drug therapy Drugs Dysplasia Epidemiology Europe Evidence-based practice Gestational Age Health aspects Hospitals Humans Infant Infant, Newborn Infant, Premature Infants Inflammation Intensive care Intensive Care Units Intensive Care Units, Neonatal Life Sciences Lung diseases Management Mechanical ventilation Medicine and health sciences Mortality Neonatal Neonates Neurodevelopmental disorders Newborn Newborn babies Nonsteroidal anti-inflammatory drugs Paralysis Pediatrics People and Places Physical Sciences Population studies Population-based studies Postnatal care Premature Premature birth Premature infants Prevention Questionnaires Regression analysis Respiratory distress syndrome Risk Small for gestational age Statistical analysis Surfactants Ventilation |
| title | Evidence-Based Neonatal Unit Practices and Determinants of Postnatal Corticosteroid-Use in Preterm Births below 30 Weeks GA in Europe. A Population-Based Cohort Study |
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