Very premature infants: towards better care

Born too soon, very premature infants are particularly vulnerable and need appropriate care. The European project EPICE (Effective Perinatal Intensive Care in Europe) examines how medical practices based on scientific evidence are incorporated into the care of these neonates[1]. The study, coordinated by Inserm and published in The British Medical Journal, highlights the underuse of four effective practices for improving their survival and long-term health, and estimates its impact on mortality and morbidity.

Soins du nourrisson

(c) Inserm/Depardieu, Michel

Very premature infants, born before 32 weeks of gestation, (8th month of pregnancy), represent 1–2% of all births. For these neonates, the risks of mortality and long-term neurological disorders are higher than for infants born at full term. It is essential to provide them with appropriate care in order to guarantee them better health.

The EPICE project created a population cohort in 2011, comprising all very premature infants from 19 regions in 11 countries of the European Union (Belgium, Denmark, Estonia, France, Germany, Italy, the Netherlands, Poland, Portugal, Sweden and the United Kingdom). The goal of the project is to evaluate the “evidence-based medical practices” applied to these infants.

Evidence-based medicine, which takes research data, clinical expertise, and patient needs into consideration, enables health professionals to make care choices based on proven clinical efficacy. In this study, Jennifer Zeitlin, Inserm Research Director, studied four of these medical practices in particular, in order to measure their impact on neonatal mortality:

– transfer of pregnant women to specialised centres designed to accommodate very premature infants,

– antenatal administration of corticosteroids (for maturation of the lungs),

– prevention of hypothermia,

– administration of surfactant (an essential substance for respiratory function that lines the pulmonary alveoli) within 2 hours after birth, or nasal positive pressure ventilation, for infants born before 28 weeks of gestation


While there was frequent use of each practice individually (75–89%), only 58% of very premature infants received all four recommended practices.

The study simulated two models to measure the impact of this inadequate care. If every infant had received all four recommended practices, mortality would have been reduced by 18%. These results demonstrate the importance of evidence-based medical care in improving the health of very premature infants.



“Effective Perinatal Intensive Care in Europe: translating knowledge into evidence-based practice”

The EPICE project is dedicated to the medical care of very preterm infants born before 32 weeks of gestation, in eleven European countries. The aim of the project is to assess practices in order to improve health care for this population of high risk babies.

The EPICE project was launched in 2011 and has been supported by the European Union (FP7) for five years. It is coordinated by Inserm, just like 27 other European “health” projects. The project involves 12 partners and 6 associate partners, based in 11 European countries.

The 12 partners:

Inserm (coordinator), France

SPE, Belgium

Hvidore Hospital, Denmark

Universitas Tartuensis, Estonia

Philipps Universität Marburg, Germany

Bambino Gesu Ospedale Pediatrico, Italy

Laziosanita Agenzia Di Sanita Pubblica, Italy

Radboud University Nijmegen Medical Centre, the Netherlands

Poznan University of Medical Sciences, Poland

U.Porto, Portugal

University of Leicester, United Kingdom

Karolinska Institutet, Sweden


EPICE in France

The EPICE project in France is part of a national study entitled EPIPAGE 2 (an epidemiological study on very preterm babies). It is a cohort study of very preterm infants, launched in 2011 in the 22 regions of mainland France and the French overseas departments. The study will monitor over 6000 premature children up to the age of 11 to 12. Three regions in France: Ile-de-France, Nord-Pas-de-Calais and Bourgogne participate in EPICE project.

The EPIPAGE 2 project is managed by the Inserm unit 953 (“Epidemiological research into perinatal health and the health of women and infants”), in collaboration with team 2, from UMRS 1027, directed by Dr Catherine Arnaud (Perinatal epidemiology, handicap of child and health of adolescents.

For further information on this study: (Head of studies: Pierre-Yves Ancel, Inserm U953)



How fatigue influences our decision-making

To resist the temptation of a beer in order to save and buy a bike later? At the end of the day, fatigue would encourage us to choose the immediate reward instead. This is what is revealed by a study published in PNAS and conducted by Bastien Blain, a researcher at Inserm Unit 1127.

Behavioural experiments were carried out on 50 people with an average age of 24 years, divided into 3 groups. One group of participants had to solve complicated exercises for a period of over 6 hours. By comparison, the second group had to work on simple exercises, while the last group played video games or read articles. At regular intervals, the researchers asked all participants to choose between receiving a small sum of money immediately, or a larger sum of money later.

Results show that a prolonged cognitive task favours impulsive choice, and that this decision is linked to reduced activity in a region of the brain involved both in these exercises and in monetary choices.

In conclusion, several hours of intense work may lead us to choose the short-term reward instead of a greater, more long-term benefit. It is therefore better to avoid making an important decision, especially of a financial nature, at the end of the day.

Frustrated office manager overloaded with work.

(c) Fotolia

Yves Lévy, Chairman and CEO of Inserm, appointed member of the UN “Global Health Crises” Task Force

UN Secretary-General Mr Ban Ki-moon has just announced the creation of a “Global Health Crises” Task Force, which will bring together 3 co-leads and 12 members, including Inserm Chairman and CEO Yves Lévy. The Task Force will ensure the implementation and monitoring of the recommendations of the report, “Protecting humanity from future health crises,” submitted to the UN Secretary-General in February 2016 by the High-level Panel on the Global Response to Health Crises[1]. The main mission of the Task Force will be to alert the UN Secretary-General on matters related to emerging crises and any gaps or weaknesses in the world health system.

Yves Lévy

Le Professeur Yves Lévy, Président-directeur général de l’Inserm.

©Inserm/Guénet, François

The members of the Task Force are internationally renowned figures in the area of infectious diseases, community healthcare, public health and development, risk assessment, implementation of humanitarian actions, and emergency management of epidemics with respect to research and innovation.

“It is an immense honour to have been appointed as a member of this international task force by the UN Secretary-General, to fulfil this ambitious mission,” says Yves Lévy, Chairman and CEO of Inserm. “Like the REACTing consortium (REsearch and ACTion targeting emerging infectious diseases), spearheaded by Inserm and Aviesan in 2013 to improve research preparation in periods between crises, and establish research projects in periods of epidemic crisis, I hope our work will contribute to strengthening the systems, throughout the world, that can assist the global response to the emergence of epidemics. It has become a key health issue for the planet.”

The Task Force will exercise its functions for one year, starting in July 2016.

The Task Force will be co-led by Jan Eliasson, UN Deputy Secretary-General, Jim Yong Kim, President of the World Bank Group and Margaret Chan, Director-General of WHO. The Deputy Secretary-General will serve as Chair of the Task Force.

The list of co-leads and members of the Task Force is accessible via the link below:


[1] This panel was established in April 2015 by Secretary-General Ban Ki-moon to strengthen national and international systems to prevent and manage health crises, taking into account lessons learned from the response to the emergence of Ebola virus in West Africa in early 2015.