{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T23:12:49Z","timestamp":1789945969133,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,5,5]],"date-time":"2017-05-05T00:00:00Z","timestamp":1493942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (<jats:styled-content style=\"fixed-case\">EPTI<\/jats:styled-content>s) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Population\u2010based cohort studies in 2003 (<jats:styled-content style=\"fixed-case\">MOSAIC<\/jats:styled-content> study) and 2011\/2012 (<jats:styled-content style=\"fixed-case\">EPICE<\/jats:styled-content> study) and questionnaires from hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>70 hospitals in ten European regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Infants born at &lt;27 weeks of gestational age (<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>) in hospitals participating in both the <jats:styled-content style=\"fixed-case\">MOSAIC<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">EPICE<\/jats:styled-content> studies (1240 in 2003, 1293 in 2011\/2012).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used McNemar's Chi<jats:sup>2<\/jats:sup> test, paired <jats:italic>t<\/jats:italic>\u2010tests and conditional logistic regression for comparisons over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes measures<\/jats:title><jats:p>Reported policies, mortality and morbidity of <jats:styled-content style=\"fixed-case\">EPTI<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The lowest <jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> at which maternity units reported performing a caesarean section for acute distress of a singleton non\u2010malformed fetus decreased from an average of 24.7 to 24.1 weeks (<jats:italic>P<\/jats:italic> &lt; 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (<jats:italic>P<\/jats:italic> = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks <jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In\u2010hospital mortality after live birth for <jats:styled-content style=\"fixed-case\">EPTI<\/jats:styled-content>s decreased from 50% to 42% (<jats:italic>P<\/jats:italic> &lt; 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; <jats:italic>P<\/jats:italic> &lt; 0.01) and experienced larger declines (55 to 44%; <jats:italic>P<\/jats:italic> &lt; 0.001) than units where policies stayed the same (43 to 37%; <jats:italic>P<\/jats:italic> = 0.1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>European hospitals reporting changes in management policies experienced larger survival gains for <jats:styled-content style=\"fixed-case\">EPTI<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Changes in reported policies for management of extremely preterm births were related to mortality declines.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14639","type":"journal-article","created":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T17:33:16Z","timestamp":1489512796000},"page":"1595-1604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Changes in management policies for extremely preterm births and neonatal outcomes from 2003 to 2012: two population\u2010based studies in ten European regions"],"prefix":"10.1111","volume":"124","author":[{"given":"M","family":"Bonet","sequence":"first","affiliation":[{"name":"Inserm UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epop\u00e9) Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Cuttini","sequence":"additional","affiliation":[{"name":"Clinical Care and Management Innovation Research Area Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Piedvache","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epop\u00e9) Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 DHU Risks in Pregnancy Paris Descartes University Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"EM","family":"Boyle","sequence":"additional","affiliation":[{"name":"Department of Health Sciences University of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PH","family":"Jarreau","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine et R\u00e9animation n\u00e9onatales de Port\u2010Royal DHU Risks in Pregnancy Universit\u00e9 Paris Descartes and Assistance Publique H\u00f4pitaux de Paris H\u00f4pitaux Universitaire Paris Centre 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