Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e815-e825 (doi:10.1542/10.1542/peds.2006-3122)

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ARTICLE

Characteristics of Neonatal Units That Care for Very Preterm Infants in Europe: Results From the MOSAIC Study

Patrick Van Reempts, MD, PhD^a, Ludwig Gortner, MD, PhD^b, David Milligan, MD^c, Marina Cuttini, MD, PhD^d, Stavros Petrou, PhD^e, Rocco Agostino, MD^f, David Field, MD^g, Lya den Ouden, MD, PhD^h, Klaus Børch, MDⁱ, Jan Mazela, MD^j, Manuel Carrapato, MD^k, Jennifer Zeitlin, DSc^l for the MOSAIC Research Group

^a Department of Neonatology, Antwerp University Hospital, University of Antwerp and Study Centre for Perinatal Epidemiology, Flanders, Belgium
^b Pediatric University Hospital, University of Saarland, Homburg, Germany
^c Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
^d Unit of Epidemiology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
^e National Perinatal Epidemiology Unit, Oxford, United Kingdom
^f Department for Mother's and Infant's Health, Hospital S. Giovanni Calibita–Fatebenefratelli, Rome, Italy
^g Department of Health Science, University of Leicester, Neonatal Unit, Leicester Royal Infirmary, Leicester, United Kingdom
^h Health Care Inspectorate, Ministry of Health, Welfare and Sports, the Hague, Netherlands
ⁱ Department of Pediatrics, Hvidovre University Hospital, Hvidore, Denmark
^j Department of Neonatology, University of Medical Sciences, Poznan, Poland
^k Department of Pediatrics, Hospital de São Sebastião, Sta Maria da Feira, Portugal
^l Institut National de la Santé et de la Recherche Médicale, UMR S149, Epidemiological Research Unit on Perinatal and Women's Health, and Université Pierre et Marie Curie-Paris 6, Paris, France

OBJECTIVES. We sought to compare guidelines for level III units in 10 European regions and analyze the characteristics of neonatal units that care for very preterm infants.

METHODS. The MOSAIC (Models of Organising Access to Intensive Care for Very Preterm Births) project combined a prospective cohort study on all births between 22 and 31 completed weeks of gestation in 10 European regions and a survey of neonatal unit characteristics. Units that admitted 5 infants at <32 weeks of gestation were included in the analysis (N = 111). Place of hospitalization of infants who were admitted to neonatal care was analyzed by using the cohort data (N = 4947). National or regional guidelines for level III units were reviewed.

RESULTS. Six of 9 guidelines for level III units included minimum size criteria, based on number of intensive care beds (6 guidelines), neonatal admissions (2), ventilated patients (1), obstetric intensive care beds (1), and deliveries (2). The characteristics of level III units varied, and many were small or unspecialized by recommended criteria: 36% had fewer than 50 very preterm annual admissions, 22% ventilated fewer than 50 infants annually, and 28% had fewer than 6 intensive care beds. Level II units were less specialized, but some provided mechanical ventilation (57%) or high-frequency ventilation (20%) or had neonatal surgery facilities (17%). Sixty-nine percent of level III and 36% of level I or II units had continuous medical coverage by a qualified pediatrician. Twenty-two percent of infants who were <28 weeks of gestation were treated in units that admitted fewer than 50 very preterm infants annually (range: 2%–54% across the study regions).

CONCLUSIONS. No consensus exists in Europe about size or other criteria for NICUs. A better understanding of the characteristics associated with high-quality neonatal care is needed, given the high proportion of very preterm infants who are cared for in units that are considered small or less specialized by many recommendations.

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Key Words: very preterm infants • neonatal intensive care • level III unit • organization of care • regionalization

Abbreviations: IC—intensive care • MOSAIC—Models of Organising Access to Intensive Care for Very Preterm Births • CPAP—continuous positive airway pressure

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Accepted Feb 23, 2007.

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				D Field, E S Draper, A Fenton, E Papiernik, J Zeitlin, B Blondel, M Cuttini, R F Maier, T Weber, M Carrapato, et al. Rates of very preterm birth in Europe and neonatal mortality rates Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2009; 94(4): F253 - F256. [Abstract] [Full Text] [PDF]