World Prematurity Day

World Prematurity Day is celebrated on November 17th.

Each year, 15 million babies are born premature (less than 37 weeks of gestation). Prematurity is the leading cause of death in children under five years of age. Due to prenatal and neonatal care, survival rates have improved over the past 40 years, reaching 80-90% in developed countries. However, among survivors, the frequency of illness and health problems is substantial, both in the short and long term.

Therefore, research is essential to look for solutions to improve the survival and quality of life of premature babies.

In 2020, the Instituto de Saúde Pública da Universidade do Porto (ISPUP) continued the work developed within the  HAPP-e cohort, the first online cohort of premature adults worldwide, to study the health of adults born prematurely, using digital tools.

Several studies have also been published in international journals, many of which are based on data from the European project EPICE/SHIPS.

Here are some of the articles that have been published:

Cohort profile: Effective Perinatal Intensive Care in Europe (EPICE) very preterm birth cohort: this article described the profile of the European cohort EPICE, in which 6,792 children from 19 regions of 11 European countries (including Portugal) participate. The children, who were born very preterm (between 22 and 31 weeks of gestation), were recruited in 2011/2012. The article is available HERE.

Managing mother’s own milk for very preterm infants in neonatal units in 11 European countries: in this study, the practices of handling and administering breast milk to very preterm infants in several Neonatal Intensive Care Units (NICUs) from 11 European countries were compared. The study concluded that the mothers’ own milk handling practices varied between countries and even within NICUs in the same country. These variations may reflect the lack of recommendations on the best practices to be adopted in this area at the international level. The article is available HERE.

What drives change in neonatal intensive care units? A qualitative study with physicians and nurses in six European countries: this study explored the factors that lead to the introduction of clinical and organizational changes in NICUs. Doctors and nurses from six European countries were interviewed, and the study concluded that there are several factors that motivate the introduction of norms or innovative treatments in NICUs. There are reasons external to the Unit, such as the publication of a new regulation or official guideline that must be implemented, and external factors, such as the occurrence of adverse events and the desire to improve health care, as well as participation in research projects and conferences. The article is available HERE.

– Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort): the findings of this analysis, using data from the European EPICE cohort study, suggested the absence of obstetric or neonatal benefits associated with the use of tocolysis, specifically when evidence-based treatments (antenatal steroids and antibiotics) are routinely offered to women with preterm premature rupture of membranes. The article is available HERE.

The impact of choice of norms on classification of motor impairment for children born very preterm: this study focused on the implications of using reference standards for the classification of motor functioning in a cohort of five-year-old Portuguese children born very preterm, using Movement ABC 2. This is a test with age-adjusted standards that, like many other psychological tests, does not have reference standards for the Portuguese population to date. The results of the article revealed that, depending on the reference standards used, the prevalence of significant motor problems in these children varied between 11% and 29%. The use of different standards has a major impact on the proportion of children classified as having significant movement difficulties, which has implications for referral for treatment and health costs. The article is available HERE.

– Prematurity-related Knowledge Among Mothers and Fathers of Very Preterm Infants: the study concluded thatmothers and fathers who experienced having at least one very premature child (born before 32 weeks of gestation) have gaps in knowledge regarding the causes and consequences of prematurity. The article, which is available HERE, assessed the knowledge of 196 parents on the prevalence of prematurity in Portugal, and regarding the causes and consequences of preterm birth.

– Neurodevelopment at age 2 and umbilical artery Doppler in cases of preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: the EPIPAGE 2 prospective population-based cohort study: an abnormal umbilical artery Doppler result is associated with perinatal death, particularly in children born very preterm due to fetal growth restriction and/or maternal hypertensive disorder. This study (available HERE) highlights that there is also a higher risk of neuromotor and/or sensory disability among survivors with absent or reversed end-diastolic flow, compared to those with normal or reduced end-diastolic flow.

The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study: an analysis of 1700 twins from the EPIPAGE-2 cohort study confirmed that monochorionic pregnancies are at increased risk of adverse perinatal outcomes. However, once admitted to NICUs, the outcomes for preterm twins are comparable regardless of their chorionicity. The article is available HERE.

– Planned delivery route and outcomes of cephalic singletons born spontaneously at 24-31 weeks’ gestation: The EPIPAGE-2 cohort study: the delivery mode of premature infants remains a major concern in daily practice. This study shows that a planned cesarean delivery does not improve neonatal outcomes in comparison with planned vaginal delivery for babies born in cephalic presentation at 24-31 weeks’ gestation after preterm labor or preterm premature rupture of membranes. The article is available HERE.

– Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study: using data from the French EPIPAGE-2 cohort, this study concluded that mothers who had a caesarean delivery, before 26 weeks of gestation, had a higher risk of developing symptoms of depression, compared to mothers who had cesarean deliveries after 26 weeks. The article is available HERE.

– Association of Chorioamnionitis With Cerebral Palsy at Two Years After Spontaneous Very Preterm Birth: The EPIPAGE-2 Cohort Study: based on the French EPIPAGE-2 cohort study, this study showed an increase in the risk of cerebral palsy (the most common cause of motor deficiency in young children) at two years among babies who were born very preterm after spontaneous preterm labor or rupture of membranes and who had been exposed to clinical chorioamnionitis. The article is available HERE.

– Improving Understanding of Participation and Attrition Phenomena in European Cohort Studies: Protocol for a Multi-Situated Qualitative Study: this study included 92 participants from European cohorts of children and adults, from six countries with different socioeconomic and cultural configurations. The objective was to understand the phenomena that lead to the participation in or abandonment of cohorts, to outline new strategies that help increase the retention and participation of the individuals. The article, which can be consulted HERE, highlights the importance of exploring the interaction between researchers in the cohorts and their participants, in order to bridge the existing gaps regarding the lack of knowledge on the variability of participation and the effectiveness of the different strategies implemented to foster adherence.

Image: Pixabay/bingngu93

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