Anna-Veera Seppänen1,2, Florence Bodeau-Livinec3,4, Elaine M Boyle5, Anna-Karin Edstedt-Bonamy6,7, Marina Cuttini8, Liis Toome9,10, Rolf F Maier11, Eva Cloet12,13, Corine Koopman-Esseboom14, Pernille Pedersen15, Janusz Gadzinowski16, Henrique Barros17, Jennifer Zeitlin1. 1. Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France. 2. Collège Doctoral, Sorbonne Université, Paris, France. 3. Ecole des Hautes Etudes en Santé Publique, Rennes, France. 4. DHU Risks in Pregnancy, Paris Descartes University, Paris, France. 5. Department of Health Sciences, University of Leicester, Leicester, UK. 6. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 7. Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. 8. Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy. 9. Tallinn Children's Hospital, Tallinn, Estonia. 10. University of Tartu, Tartu, Estonia. 11. Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany. 12. Public Health, Vrije Universiteit Brussel Faculteit Geneeskunde en Farmacie, Brussels, Belgium. 13. Paediatric Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium. 14. Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands. 15. Department of Neonatology, Hvidovre Hospital, Hvidovre, Denmark. 16. Department of Neonatology, Poznan University of Medical Sciences, Poznań, Poland. 17. ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.
Abstract
AIM: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.
AIM: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe. METHOD: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace. RESULTS: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries. INTERPRETATION: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care. WHAT THIS PAPER ADDS: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services.
Authors: Jennifer Zeitlin; Rolf F Maier; Marina Cuttini; Ulrika Aden; Klaus Boerch; Janusz Gadzinowski; Pierre-Henri Jarreau; Jo Lebeer; Mikael Norman; Pernille Pedersen; Stavros Petrou; Johanna M Pfeil; Liis Toome; Arno van Heijst; Patrick Van Reempts; Heili Varendi; Henrique Barros; Elizabeth S Draper Journal: Int J Epidemiol Date: 2020-04-01 Impact factor: 7.196