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Original research
Trends in the survival of very preterm infants between 2011 and 2020 in France
  1. Victoria Butler1,2,
  2. Luc Gaulard1,
  3. Victor Sartorius1,3,
  4. Pierre Yves Ancel1,4,
  5. François Goffinet1,5,
  6. Jeanne Fresson1,6,
  7. Jennifer Zeitlin1,
  8. Héloïse Torchin1,2
  1. 1 Centre for Research in Epidemiology and Statistics Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, Île-de-France, France
  2. 2 Neonatal Intensive Care Unit, Port-Royal Maternity, Paris, France
  3. 3 Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris, Île-de-France, France
  4. 4 Clinical Research Unit, Centre for Clinical Investigation P1419, Paris, France
  5. 5 Maternity Unit of Port Royal, Assistance Publique—Hôpitaux de Paris, Cochin Hospital, Paris, France
  6. 6 Department of Medical Information, Nancy, France
  1. Correspondence to Dr Victoria Butler; victoria.butler{at}aphp.fr

Abstract

Objective The objective is to evaluate changes in survival to discharge of liveborn infants less than 32 weeks’ gestational age (GA) in France, where the latest available data on very preterm survival at a national-level are from the EPIPAGE-2 (Etude épidémiologique sur les petits âges gestationnels) cohort in 2011.

Design Population-based cohort study.

Setting Metropolitan France in 2011, 2015 and 2020.

Patients All births between 22 and 31 weeks’ GA using the EPIPAGE-2 cohort study for the year 2011 and hospital discharge data linked to death certificates from the Système National des Données de Santé for the years 2015 and 2020.

Main outcome measures The primary outcome was survival to hospital discharge among liveborn infants. Survival rates were compared using modified Poisson regression and adjusted for population characteristics (maternal age, multiple birth, sex, small for GA). Data on all births were examined to assess changes to the live birth rate.

Results Survival to discharge among live births increased at 23 and 24 weeks’ GA from 1% and 31% in 2011 to 8% and 37% in 2015 and to 31% and 47% in 2020, respectively. From 25 to 28 weeks’ GA, survival rates tended to increase, but differences were not significant, and survival rates were stable from 29 to 31 weeks GA. Results were similar after adjustment. The proportion of live births versus stillbirths increased from 22 to 24 weeks’ GA.

Conclusion Survival rates among live births improved between 2011 and 2020 from 23 to 28 weeks’ GA, with marked changes at 23 and 24 weeks’ GA.

  • Epidemiology
  • Intensive Care Units, Neonatal
  • Neonatology
  • Mortality
  • Resuscitation

Data availability statement

Data may be obtained from a third party and are not publicly available. No data are available.

https://doi.org/10.1136/archdischild-2024-327814

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. No data are available.

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    Footnotes

    • Contributors VB, HT and JZ conceptualised and designed the study, conducted the analyses and drafted the initial manuscript. PYA, FG, VS, JF and LG critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. VB is the guarantor.

    • Funding VB was supported by the French Society of Neonatology for this study. The EPIPAGE 2 project was funded with support from: The French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, and the National Solidarity Fund for Autonomy. The National Research Agency through the French EQUIPEX program of investments in the future (reference ANR-11-EQPX-0038 and ANR-19-COHO-001), The PremUP Foundation, Fondation de France (Reference 11779), Fondation pour la Recherche Médicale (SPF20160936356), Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation (G13129KK), Apicil Foundation (R20065KK). The QUALI-N project funded by the Agence technique de l'information sur l'hospitalisation (ATIH, Agency for Information on Hospital Care) provided support for the creation of the mother-baby cohort and statistical analysis. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.