{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T09:29:12Z","timestamp":1789896552107,"version":"4.0.1"},"reference-count":36,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2020,6,22]],"date-time":"2020-06-22T00:00:00Z","timestamp":1592784000000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe patterns of care for very preterm (VP) babies across neonatal intensive care units (NICUs) and associations with outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study, EPIPAGE-2.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>France, 2011.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>53 (NICUs); 2135 VP neonates born at 27 to 31 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>Clusters of units, defined by the association of practices in five neonatal care domains \u2013 respiratory, cardiovascular, nutrition, pain management and neurodevelopmental care. Mortality at 2 years corrected age (CA) or severe\/moderate neuro-motor or sensory disabilities and proportion of children with scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Hierarchical cluster analysis to identify clusters of units. Comparison of outcomes between clusters, after adjustment for potential cofounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three clusters were identified: Cluster 1 with higher proportions of neonates free of mechanical ventilation at 24\u2009hours of life, receiving early enteral feeding, and neurodevelopmental care practices (26 units; n=1118 babies); Cluster 2 with higher levels of patent ductus arteriosus and pain screening (11 units; n=398 babies); Cluster 3 with higher use of respiratory, cardiovascular and pain treatments (16 units; n=619 babies). No difference was observed between clusters for the baseline maternal and babies\u2019 characteristics. No differences in outcomes were observed between Clusters 1 and 3. Compared with Cluster 1, mortality at 2 years CA or severe\/moderate neuro-motor or sensory disabilities was lower in Cluster 2 (adjusted OR 0.46, 95%\u2009CI 0.25 to 0.84) but with higher proportion of children with an ASQ below threshold (adjusted OR 1.49, 95%\u2009CI 1.07 to 2.08).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In French NICUs, care practices for VP babies were non-randomly associated. Differences between clusters were poorly explained by unit or population differences, but were associated with mortality and development at 2 years. Better understanding these variations may help to improve outcomes for VPT babies, as it is likely that some of these discrepancies are unwarranted.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035075","type":"journal-article","created":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T06:10:08Z","timestamp":1592892608000},"page":"e035075","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Variations in patterns of care across neonatal units and their associations with outcomes in very preterm infants: the French EPIPAGE-2 cohort study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7435-5144","authenticated-orcid":false,"given":"Veronique","family":"Pierrat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Burguet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laetitia","family":"Marchand-Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1360-7915","authenticated-orcid":false,"given":"Gilles","family":"Cambonie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana\u00eblle","family":"Coquelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JC","family":"Roze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4038-9036","authenticated-orcid":false,"given":"Melanie","family":"Durox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Guillois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4143-1977","authenticated-orcid":false,"given":"Andrei S","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2548-2304","authenticated-orcid":false,"given":"Monique","family":"Kaminski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,22]]},"reference":[{"key":"2020062223093675000_10.6.e035075.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7370.961"},{"key":"2020062223093675000_10.6.e035075.2","unstructured":"Goodman DC , Little GA , Harrison WN , et al . 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