RT Journal Article
SR Electronic
T1 A population-based comparison of preterm neonatal deaths (22–34 gestational weeks) in France and Ontario: a cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E159
OP E166
DO 10.9778/cmajo.20180199
VO 7
IS 1
A1 Dianna Wang
A1 Abdool S. Yasseen III
A1 Laetitia Marchand-Martin
A1 Ann E. Sprague
A1 Erin Graves
A1 François Goffinet
A1 Mark Walker
A1 Pierre-Yves Ancel
A1 Thierry Lacaze-Masmonteil
YR 2019
UL http://www.cmajopen.ca/content/7/1/E159.abstract
AB Background: The management and outcomes of preterm births can vary greatly even among developed nations with the same access to medicine, technology and expertise. We aimed to compare aspects of obstetrical management and mortality for preterm infants in France and Ontario, Canada.Methods: The Better Outcomes Registry & Network (BORN) Information System in Ontario and Épidémiologique sur les petits âges gestationnels (EPIPAGE-2) in France collected information on maternal demographics, obstetrical characteristics, obstetrical interventions and neonatal outcomes for infants born between 22 and 34 weeks gestation. We used standardized covariate definitions and extracted data from 2011 (for EPIPAGE-2) and from 2012 and 2013 (for BORN) to conduct a cohort study comparing the 2 data sets (stratified into gestational age groups of 22–26, 27–31 and 32–34 wk) using multivariable logistic regression models.Results: Mothers in the BORN cohort were older (30.7 yr v. 29.6 yr) but less likely to have gestational hypertension (13.4% v. 17.9%) than those in the EPIPAGE-2 cohort. Infants from EPIPAGE-2 had lower birth weights (1.3 kg v. 1.5 kg) and were more likely to be born in an institution with level 3 care (71.9% v. 55.8%). After adjustment for these differences, there was significantly higher neonatal mortality among infants from EPIPAGE-2 in the 22–26 week gestation age group (adjusted odds ratio 2.81; 95% confidence interval 1.17 to 6.74).Interpretation: Even after we adjusted for both intrinsic population differences and differences in management between Ontario and France, we found a higher rate of neonatal mortality at earlier gestational ages in France. This may be related to differences in ethical approaches and/or postnatal management and should be explored further.