A European study found that using all 4 of the investigated evidence-based practices may reduce both infant mortality and severe infant morbidity and therefore better the outcome of very preterm infants.
Only 2% of all infants are very preterm, born between 24-32 gestational weeks. These babies accounts for more than 50% of all infant deaths and severe infant morbidity, such as cerebral palsy, visual or auditory deficits, cognitive impairments, psychological disorders and behavioral problems. Despite the fact that with the application of evidence-based practices in their care a better outcome may be reached, practices that have been shown to be effective are not always used, because of organisational, cultural or personal barriers.
In a new article, published in the British Medical Journal, a European study group investigated the efficacy of four evidence-based practices in the treatment of very preterm infants in 11 countries in Europe. The four practices were: delivery in a maternity unit with neonatal care services, administration of antenatal corticosteroids (proven to help in the maturation of the lungs), prevention of hypothermia (temperature does not go under 36°C), and the utilization of surfactant (a substance that preterm infants often lack and helps them breath) or early nasal positive airway pressure.
7336 infants from the EPICE cohort (Effective Perinatal Intensive Care in Europe, cohort that includes 19 regions of 11 European countries) were included in this study, which were born between 24-32 weeks of gestational age. Infants, who died on the labour ward or who had serious congenital anomalies were excluded. The mean gestational age upon delivery was 28.7 weeks, while the mean birth weight was 1224g. In hospital mortality was 9.2%, and severe neonatal morbidity affected 10.3% of newborns. As for the evidence-based practices, 88.2% of the infants were delivered in a hospital with neonatal care unit, antenatal steroid was administered in 89.2% of the cases, hypothermia was prevented in 74.4% of the preemies, and 83% of the babies received either surfactant or early nasal positive airway pressure. All 4 procedures were performed in only 58.3% of the infants, while only 9.2% of the newborns received less than 2 treatments. Furthermore, babies who were born before 26 weeks and had lower Apgar scores (a measurement of the health status of the newborn) were less likely to receive all four treatments. The authors found that in infants who received all 4 evidence based treatments, mortality rate was 28% lower, while severe infant morbidity rate was 18% lower than in those infants who did not get all the available treatments. They also investigated if the effect depended upon how many evidence-based practices were used. Results show that compared to those infants who received all 4 practices, those who received less had a higher risk for infant mortality (3 practices: 1.32, 2 practices: 1.55, 1 practice 1.81 times higher risk). A simulation has shown that if all 4 practices had been used in all infants, mortality rate could have been reduced by 17.9% and severe morbidity by 11.3%.
It seems that there are big differences in the utilization of evidence-based practices among Western-European countries and regions. Moreover, only 58.3% of all very preterm infants received all 4 practices that were included in this study, while based on this study, both mortality and morbidity could be reduced when all 4 practices are used. The authors suggest that a more comprehensive use of these easily accessible practices could make a big difference in the outcome of very preterm infants.
Written By: Dr. Fanni R. Eros