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

Variation in follow-up for children born very preterm in Europe

Background: Children born very preterm (<32 weeks of gestation) face high risks of neurodevelopmental and health difficulties compared with children born at term. Follow-up after discharge from the neonatal intensive care unit is essential to ensure early detection and intervention, but data on policy approaches are sparse. Methods: We investigated the characteristics of follow-up policy and programmes in 11 European countries from 2011 to 2022 using healthcare informant questionnaires and the published/grey literature. We further explored how one aspect of follow-up, its recommended duration, may be reflected in the percent of parents reporting that their children are receiving follow-up services at 5 years of age in these countries using data from an area-based cohort of very preterm births in 2011/12 (N = 3635). Results: Between 2011/12 and 22, the number of countries with follow-up policies or programmes increased from 6 to 11. The policies and programmes were heterogeneous in eligibility criteria, duration and content. In countries that recommended longer follow-up, parent-reported follow-up rates at 5 years of age were higher, especially among the highest risk children, born <28 weeks’ gestation or with birthweight <1000 g: between 42.1% and 70.1%, vs. <20% in most countries without recommendations. Conclusions: Large variations exist in follow-up policies and programmes for children born very preterm in Europe; differences in recommended duration translate into cross-country disparities in reported follow-up at 5 years of age

Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort

Administration-to-birth intervals of antenatal corticosteroids (ANS) vary. The significance of this variation is unclear. Specifically, to our knowledge, the shortest effective administration-to-birth interval is unknown. Objective:To explore the associations between ANS administration-to-birth interval and survival and morbidity among very preterm infants. Design, Setting, and Participants: The Effective Perinatal Intensive Care in Europe (EPICE) study, a population-based prospective cohort study, gathered data from 19 regions in 11 European countries in 2011 and 2012 on 4594 singleton infants with gestational ages between 24 and 31 weeks, without severe anomalies and unexposed to repeated courses of ANS. Data were analyzed November 2016. Exposure: Time from first injection of ANS to delivery in hours and days. Main Outcomes and Measures: Three outcomes were studied: in-hospital mortality; a composite of mortality or severe neonatal morbidity, defined as an intraventricular hemorrhage grade of 3 or greater, cystic periventricular leukomalacia, surgical necrotizing enterocolitis, or stage 3 or greater retinopathy of prematurity; and severe neonatal brain injury, defined as an intraventricular hemorrhage grade of 3 or greater or cystic periventricular leukomalacia. Results: Of the 4594 infants included in the cohort, 2496 infants (54.3%) were boys, and the mean (SD) gestational age was 28.5 (2.2) weeks and mean (SD) birth weight was 1213 (400) g. Mortality for the 662 infants (14.4%) unexposed to ANS was 20.6% (136 of 661). Administration of ANS was associated with an immediate and rapid decline in mortality, reaching a plateau with more than 50% risk reduction after an administration-to-birth interval of 18 to 36 hours. A similar pattern for timing was seen for the composite mortality or morbidity outcome, whereas a significant risk reduction of severe neonatal brain injury was associated with longer administration-to-birth intervals (greater than 48 hours). For all outcomes, the risk reduction associated with ANS was transient, with increasing mortality and risk for severe neonatal brain injury associated with administration-to-birth intervals exceeding 1 week. Under the assumption of a causal relationship between timing of ANS and mortality, a simulation of ANS administered 3 hours before delivery to infants who did not receive ANS showed that their estimated decline in mortality would be 26%. Conclusions and Relevance:Antenatal corticosteroids may be effective even if given only hours before delivery. Therefore, the infants of pregnant women at risk of imminent preterm delivery may benefit from its use.The research received funding from grant agreement 259882 from the European Union Seventh Framework Program (2007-2013). Additional funding in France was provided by the French Institute of Public Health Research/Institute of Public Health and its partners, including the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy, by grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future, and by the PremUp Foundation; in Poland, by 2012-2015 allocation of funds for international projects from the Polish Ministry of Science and HigherEducation; and in Sweden, by regional agreementon medical training and clinical research betweenStockholm County Council and Karolinska Institutetand by the Department of Neonat al Medicine at theKarolinska University Hospital

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

Spectators, who are they? A demographic analysis of theatre audiences in four European cities

When speculating on how theatre functions in a society, the most obvious questions are how many people make use of the theatre that is on offer and, subsequently, which parts of the population make use of what types of theatrical events. In this article, both questions are answered for the cities of Debrecen in Hungary, Groningen in the Netherlands, Tyneside in the United Kingdom and Tartu in Estonia. After explaining the research design within the STEP City Study and some methodological difficulties, we attempt to present a precise picture of the different audiences, their preferences and frequencies of theatre visits. Based on the data collected in these four cities, comparative conclusions may be drawn about the parts of the population which make use of the theatre supply in general and in more detail. One remarkable outcome is that in Groningen, 8.4% of the city population makes use of the professional theatre supply for adults, whereas in Tartu, this percentage is 20.7%. Keywords: theatre audience, international comparative theatre survey, Debrecen, Groningen, Tartu, Tyneside, STE

Gledalci, kdo so?: Demografska analiza gledališkega občinstva v štirih evropskih mestih

Ko razmišljamo, kako gledališče deluje v družbenem okviru, sta najočitnejši vprašanji, koliko ljudi se poslužuje gledališke ponudbe in, posledično, kateri deli prebivalstva si ogledajo določene tipe gledaliških dogodkov. V članku na obe vprašanji odgovorimo ob primerih madžarskega mesta Debrecen, nizozemskega mesta Groningen, britanske pokrajine Tyneside in estonskega mesta Tartu. Ko pojasnimo, kako je bila zasnovana raziskava v okviru Študije mest, in razrešimo nekatere metodološke težave, poskušamo predstaviti natančno sliko različnih vrst občinstva, njegovih preferenc in pogostosti obiskov gledališča. Na podlagi podatkov, zbranih v omenjenih štirih mestih, je mogoče na splošno in podrobneje priti do primerjalnih sklepov o delih prebivalstva, ki si ogledajo gledališko ponudbo. Eden od zanimivih rezultatov pokaže, da v Groningenu poklicno gledališko ponudbo za odrasle izkoristi 8,4 % mestnega prebivalstva, medtem ko v Tartuju primerljivi delež znaša 20,7 %. Ključne besede gledališko občinstvo, raziskovanje občinstva, mednarodno primerjalno gledališko raziskovanje, Debrecen, Groningen, Tartu, Tyneside, STE

Managing mother’s own milk for very preterm infants in neonatal units in 11 European countries

International audienceno abstract availabl