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Pediatrics. 2017 Apr;139(4). pii: e20161990. doi: 10.1542/peds.2016-1990.

Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe.

Author information

1
Department of Health Sciences, University of Leicester, Leicester, United Kingdom; msn@le.ac.uk.
2
Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
3
Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy.
4
Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany.
5
Newcastle Neonatal Services, Royal Victoria Infirmary, Newcastle, United Kingdom.
6
Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.
7
Flemish Study Centre for Perinatal Epidemiology, Brussels, Belgium.
8
Departments of Medicine Solna and.
9
Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
10
Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
11
Department of Neonatology, Hvidovre University Hospital, Hvidovre, Denmark.
12
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.
13
Department of Pediatrics, University of Tartu, Tartu University Hospital, Tartu, Estonia.
14
EPIUnit Institute of Public Health, University of Porto, Porto, Portugal; and.
15
INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France.

Abstract

BACKGROUND AND OBJECTIVE:

Stillbirth and in-hospital mortality rates associated with very preterm births (VPT) vary widely across Europe. International comparisons are complicated by a lack of standardized data collection and differences in definitions, registration, and reporting. This study aims to determine what proportion of the variation in stillbirth and in-hospital VPT mortality rates persists after adjusting for population demographics, case-mix, and timing of death.

METHODS:

Standardized data collection for a geographically defined prospective cohort of VPTs (22+0-31+6 weeks gestation) across 16 regions in Europe. Crude and adjusted stillbirth and in-hospital mortality rates for VPT infants were calculated by time of death by using multinomial logistic regression models.

RESULTS:

The stillbirth and in-hospital mortality rate for VPTs was 27.7% (range, 19.9%-35.9% by region). Adjusting for maternal and pregnancy characteristics had little impact on the variation. The addition of infant characteristics reduced the variation of mortality rates by approximately one-fifth (4.8% to 3.9%). The SD for deaths <12 hours after birth was reduced by one-quarter, but did not change after risk adjustment for deaths ≥12 hours after birth.

CONCLUSIONS:

In terms of the regional variation in overall VPT mortality, over four-fifths of the variation could not be accounted for by maternal, pregnancy, and infant characteristics. Investigation of the timing of death showed that these characteristics only accounted for a small proportion of the variation in VPT deaths. These findings suggest that there may be an inequity in the quality of care provision and treatment of VPT infants across Europe.

PMID:
28341800
DOI:
10.1542/peds.2016-1990
[Indexed for MEDLINE]
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