Variability in very preterm stillbirth and in-hospital mortality across Europe

Elizabeth S. Draper, Bradley N. Manktelow, Marina Cuttini, Rolf F. Maier, Alan C. Fenton, Patrick Van Reempts, Anna Karin Bonamy, Jan Mazela, Klaus Børch, Corinne Koopman-Esseboom, Heili Varendi, Henrique Barros, Jennifer J. Zeitlin

Research output: Contribution to journalArticle

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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. Copyright c 2017 by the American Academy of Pediatrics.

Original languageEnglish
Article numbere20161990
JournalPediatrics
Volume139
Issue number4
DOIs
Publication statusPublished - Apr 1 2017

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Stillbirth
Premature Birth
Hospital Mortality
Mortality
Premature Infants
Pregnancy
Logistic Models
Mothers
Parturition
Risk Adjustment
Quality of Health Care
Birth Rate
Diagnosis-Related Groups
Demography
Pediatrics
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Draper, E. S., Manktelow, B. N., Cuttini, M., Maier, R. F., Fenton, A. C., Van Reempts, P., ... Zeitlin, J. J. (2017). Variability in very preterm stillbirth and in-hospital mortality across Europe. Pediatrics, 139(4), [e20161990]. https://doi.org/10.1542/peds.2016-1990

Variability in very preterm stillbirth and in-hospital mortality across Europe. / Draper, Elizabeth S.; Manktelow, Bradley N.; Cuttini, Marina; Maier, Rolf F.; Fenton, Alan C.; Van Reempts, Patrick; Bonamy, Anna Karin; Mazela, Jan; Børch, Klaus; Koopman-Esseboom, Corinne; Varendi, Heili; Barros, Henrique; Zeitlin, Jennifer J.

In: Pediatrics, Vol. 139, No. 4, e20161990, 01.04.2017.

Research output: Contribution to journalArticle

Draper, ES, Manktelow, BN, Cuttini, M, Maier, RF, Fenton, AC, Van Reempts, P, Bonamy, AK, Mazela, J, Børch, K, Koopman-Esseboom, C, Varendi, H, Barros, H & Zeitlin, JJ 2017, 'Variability in very preterm stillbirth and in-hospital mortality across Europe', Pediatrics, vol. 139, no. 4, e20161990. https://doi.org/10.1542/peds.2016-1990
Draper ES, Manktelow BN, Cuttini M, Maier RF, Fenton AC, Van Reempts P et al. Variability in very preterm stillbirth and in-hospital mortality across Europe. Pediatrics. 2017 Apr 1;139(4). e20161990. https://doi.org/10.1542/peds.2016-1990
Draper, Elizabeth S. ; Manktelow, Bradley N. ; Cuttini, Marina ; Maier, Rolf F. ; Fenton, Alan C. ; Van Reempts, Patrick ; Bonamy, Anna Karin ; Mazela, Jan ; Børch, Klaus ; Koopman-Esseboom, Corinne ; Varendi, Heili ; Barros, Henrique ; Zeitlin, Jennifer J. / Variability in very preterm stillbirth and in-hospital mortality across Europe. In: Pediatrics. 2017 ; Vol. 139, No. 4.
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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. Copyright c 2017 by the American Academy of Pediatrics.",
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AU - Van Reempts, Patrick

AU - Bonamy, Anna Karin

AU - Mazela, Jan

AU - Børch, Klaus

AU - Koopman-Esseboom, Corinne

AU - Varendi, Heili

AU - Barros, Henrique

AU - Zeitlin, Jennifer J.

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N2 - 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. Copyright c 2017 by the American Academy of Pediatrics.

AB - 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. Copyright c 2017 by the American Academy of Pediatrics.

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