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

PLoS One. 2017 Jan 23;12(1):e0170234. doi: 10.1371/journal.pone.0170234. eCollection 2017.

Abstract

Background: 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).

Methods: 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.

Results: 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]).

Conclusion: 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.

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Cohort Studies
  • Europe
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Intensive Care Units, Neonatal*

Substances

  • Adrenal Cortex Hormones

Grant support

The research leading to these results received funding from the European Union's Seventh Framework Programme ([FP7/2007-2013]) under grant agreement n°259882. Additional funding in some countries: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future; and the PremUp Foundation); Poland (2012-2015 allocation of funds for international projects from the Polish Ministry of Science and Higher Education); Sweden (regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, and by the Department of Neonatal Medicine, Karolinska University Hospital). UK (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire & Humber regions).