Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort

Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence‐based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36–80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU.European Union's Seventh Framework Program ([FP7/2007‐2013]). Grant Number: n°259882; Stockholm County Council Clinical Research appointment (AKEB); Swedish Order of Freemasons in Stockholm, Sweden (EW); The Portuguese Foundation for Science and Technology funds the Epidemiology Research Unit of the Institute of Public Health of the University of Porto (UID/DTP/04750/2013), Portugal. Grant Number: SFRH/BD/111794/2015 (CR

Understanding participation in European cohort studies of preterm children: The views of parents, healthcare professionals and researchers

Background: Retention of participants in cohort studies is a major challenge. A better understanding of all elements involved in participation and attrition phenomena in particular settings is needed to develop effective retention strategies. The study aimed to achieve an in-depth understanding of participant retention in longitudinal cohorts focusing on participants’ and researcher’s perspectives, across three diverse socio-geographic and cultural settings. Methods: This study used a triangulation of multi-situated methods to collect data on cohort studies of children born with less than 32 weeks of gestation in Denmark, Italy and Portugal. It included focus groups and individual semi-driven interviewing with involved key actors (i.e. parents, staff, healthcare professionals, researchers) and a collaborative visual methodology. A purposive sample of 48 key actors (n = 13 in Denmark; n = 13 in Italy; n = 22 in Portugal) was collected. A triangulation of phenomenological thematic analysis with discourse analysis was applied. Cross-contextual and context-specific situational elements involved in participation and attrition phenomena in these child cohorts were identified at various levels and stages. Results: Main findings included: situational challenges affecting potential and range of possibilities for implementation strategies (geopolitical environment, societal changes, research funding models); situational elements related to particular strategies acting as deterrents (postal questionnaires) and facilitators (multiple flexible strategies, reminders, regular interaction); main motivations to enrol and participate (altruism/solidarity and gratitude/sense of duty to reciprocate); main motivational deterrents to participate to follow-up waves (lack of bonding, insufficient feedback); entanglement of clinical and research follow-up as facilitator and deterrent. Conclusions: The multi-situated approach used, addressing the interplay of the lived experience of individuals, was of most value to understand participation variability under different implemented strategies in-context. Cross-contextual and context-specific situational elements that have been influential factors towards participation and attrition in the cohorts were identified.info:eu-repo/semantics/publishedVersio

Producing valid statistics when legislation, culture, and medical practices differ for births at or before the threshold of survival: Report of a European workshop

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Developmental motor problems and health-related quality of life in 5-year-old children born extremely preterm:A European cohort study

Aim: To measure the association between cerebral palsy (CP) and non-CP-related movement difficulties and health-related quality of life (HRQoL) among 5-year-old children born extremely preterm (&lt;28 weeks gestational age). Method: We included 5-year-old children from a multi-country, population-based cohort of children born extremely preterm in 2011 to 2012 in 11 European countries (n = 1021). Children without CP were classified using the Movement Assessment Battery for Children, Second Edition as having significant movement difficulties (≤5th centile of standardized norms) or being at risk of movement difficulties (6th–15th centile). Parents reported on a clinical CP diagnosis and HRQoL using the Pediatric Quality of Life Inventory. Associations were assessed using linear and quantile regressions. Results: Compared to children without movement difficulties, children at risk of movement difficulties, with significant movement difficulties, and CP had lower adjusted HRQoL total scores (β [95% confidence interval] = −5.0 [−7.7 to −2.3], −9.1 [−12.0 to −6.1], and − 26.1 [−31.0 to −21.2]). Quantile regression analyses showed similar decreases in HRQoL for all children with CP, whereas for children with non-CP-related movement difficulties, reductions in HRQoL were more pronounced at lower centiles. Interpretation: CP and non-CP-related movement difficulties were associated with lower HRQoL, even for children with less severe difficulties. Heterogeneous associations for non-CP-related movement difficulties raise questions for research about mitigating and protective factors.</p

Compreender a participação em estudos de coorte europeus de crianças prematuras: pontos de vista de pais, profissionais de saúde e investigadores

Contextualização: A retenção de participantes em estudos de coorte é um grande desafio. É necessária uma melhor compreensão de todos os elementos envolvidos nos fenómenos de participação e de atrito em contextos par‑ ticulares para desenvolver estratégias de retenção eficazes. O estudo visou alcançar uma compreensão aprofundada da retenção de participantes em coortes longitudinais centrando‑se tanto nas perspetivas de participantes investigados quanto de investigadores, em três cenários sociogeográficos e culturais diversos. Métodos: Este estudo utilizou uma triangulação de métodos multi‑situados para recolher dados sobre estudos de coorte de crianças nascidas com menos de 32 semanas de gestação na Dinamarca, Itália e Portugal. Incluiu uma metodologia visual colaborativa, grupos focais e entrevistas individuais semi‑‑dirigidas com atores chave envolvidos nas coortes (pais, staff, profissionais de saúde, investigadores). Foi recolhida uma amostra intencional de 48 ato‑ res chave (n=13 na Dinamarca; n=13 na Itália; n=22 em Portugal). Na análise foi aplicada uma triangulação de análise temática fenomenológica com análise do discurso. Foram identificados, em vários níveis e etapas, elementos situacionais contextualmente específicos e transversais envolvidos nos fenómenos de participação e atrito nestas coortes infantis. Resultados: Principais resultados incluíram: desafios situacionais que afetam o potencial e amplitude de possibilidades na implementação estratégica (ambiente geopolítico, mudanças sociais, modelos de financiamento da inves‑ tigação); elementos situacionais relacionados com estratégias particulares que atuam como dissuasores (questionários postais) e facilitadores (múltiplas estratégias flexíveis, lembretes, interação regular); motivações maiores para aceitar participar e continuar na coorte (altruísmo/solidariedade e gratidão/ /sentido do dever de retribuir); principais desmotivadores para participar em ondas de acompanhamento/follow‑up (fraco elo de ligação ao estudo, retorno de informação insuficiente); perceção parental de entrelaçamento dos acompanhamentos clínico e da investigação que atua quer como facilitador quer Conclusões: A utilização de uma abordagem multi‑situada, focada na interação da experiência vivida dos indivíduos envolvidos, foi da maior utilidade para compreender a variabilidade da participação sob diferentes implementações estratégicas em contexto. Foram identificados elementos situacionais contextualmente específicos e transversais que atuam como fatores influenciadores na participação e no atrito das coortes como dissuasor.info:eu-repo/semantics/publishedVersio

Can the Apgar Score be Used for International Comparisons of Newborn Health?

Background: The Apgar score has been shown to be predictive of neonatal mortality in clinical and population studies, but has not been used for international comparisons. We examined population-level distributions in Apgar scores and associations with neonatal mortality in Europe. Methods: Aggregate data on the 5 minute Apgar score for live births and neonatal mortality rates from countries participating in the Euro-Peristat project in 2004 and 2010 were analysed. Country level associations between the Apgar score and neonatal mortality were assessed using the Spearman rank correlation coefficient. Results: Twenty-three countries or regions provided data on Apgar at 5 minutes, covering 2 183 472 live births. Scores <7 ranged from 0.3% to 2.4% across countries in 2004 and 2010 and were correlated over time (q = 0.88, P < 0.01). There were large differences in healthy baby scores: scores of 10 ranged from 8.8% to 92.7% whereas scores of 9 or 10 ranged from 72.9% to 96.8%. Countries more likely to score 10 s, as opposed to 9 s, for healthy babies had lower proportions of Apgar <7 (q = 0.43, P = 0.04). Neonatal mortality rates were weakly correlated with Apgar score <7 (q = 0.06, P = 0.61), but differences over time in these two indicators were correlated (q =0.56, P = 0.02). Conclusions: Large variations in the distribution of Apgar scores likely due to national scoring practices make the Apgar score an unsuitable indicator for benchmarking newborn health across countries. However, country-level trends over time in the Apgar score may reflect real changes and merit further investigation.This study was funded by grants from the European Commission for the Euro-Peristat project: 2010 13 01 and for the Bridge Health project: 664691. The funding agency was not involved in the study. Marie Delnord received doctoral funding from Paris Descartes University, Paris, France

Cesarean delivery on maternal request: Can the ethical problem be solved by the principlist approach?

In this article, we use the principlist approach to identify, analyse and attempt to solve the ethical problem raised by a pregnant woman's request for cesarean delivery in absence of medical indications