Jasper V. Been | TU Delft Repository

Dutch nationwide registry study to identify spatial, contextual and environmental inequalities in birth outcomes

Journal article (2026) - Anna J Suleri, Loes C M Bertens, Istiaque Ahmed, Medha Pfaff, F.D. van der Hoeven, Eric A P Steegers, Jasper V Been

Introduction
The first 1000 days of life, from conception to age 2, are crucial for a child’s development, with lasting health impacts. Evidence is growing that environmental and social factors, especially the neighbourhood of birth, play a significant role in shaping health during this period. This study investigates perinatal health disparities in 20 high-risk Dutch neighbourhoods identified by the governmental National Program on Livability and Safety and outlines an initiative to develop tools aimed at reducing geographical health inequalities and improving birth outcomes.

Methods
Using data from the national perinatal registry (Perined) from 2015 to 2021, we analysed perinatal outcomes in 1 118 022 mother–child pairs, including perinatal mortality (24 weeks gestation to 7 days postbirth), small for gestational age (SGA; birthweight <10th percentile, corrected for gestational age and sex) and preterm birth (<37 weeks). Three-step logistic regression compared outcomes across all high-risk areas versus the rest of the country, each high-risk area versus national levels and each area versus its municipality, adjusting for confounders and multiple testing.

Results
We observed that SGA (OR 1.19 (95% CI 1.16 to 1.21)), preterm birth (OR 1.09 (95% CI 1.06 to 1.12)) and perinatal mortality (OR 1.13 (95% CI 1.02 to 1.24)) were significantly higher within high-risk areas compared with the rest of the Netherlands. These disparities persisted across the various comparisons.

Conclusion
Living in high-risk neighbourhoods, as defined by livability and safety parameters, is linked to adverse birth outcomes, underscoring the need for targeted, location-based policies. Our collaborative initiative aims to co-develop a knowledge agenda with key stakeholders to create actionable tools that reduce health inequalities from birth. ...

Spatial, contextual and environmental inequalities in birth outcomes

Journal article (2025) - Anna Suleri, Loes Bertens, Istiaque Ahmed, F.D. van der Hoeven, Eric Steegers, Jasper V Been

The first 1,000 days of life are a vital period for growth and development, with lasting effects on health and well-being. There is growing recognition of the importance of environmental and societal exposures, like the neighborhood a child is born into. This supports a ‘Health in All Policies’ approach, acknowledging that health is shaped by decisions beyond the healthcare sector. This study explores inequalities in perinatal health across high-risk neighborhoods in the Netherlands, as identified by the Dutch National Program on Safety and Livability (NLPV), focusing on the neighborhoods’ classification rather than their health outcomes. We used nationwide data from Perined (2015-2021) to compare perinatal outcomes among residents of 20 designated NLPV focus areas to other regions (n = 1,118,022 births). Outcomes included perinatal mortality (death from 24 weeks gestation to 7 days after birth), small for gestational age (birthweight <10th percentile), and preterm birth (before 37 weeks). A three-step logistic regression approach was applied: (1) comparing all focus areas combined to the rest of the country, (2) each focus area to the rest of the Netherlands, and (3) each to its municipality. Perinatal mortality (OR 1.13, 95% CI: 1.02-1.24), small for gestational age (OR 1.19, 95% CI: 1.16-1.21), and preterm birth (OR 1.09, 95% CI: 1.06-1.12) were all significantly more prevalent in designated focus areas compared to the rest of the Netherlands. Similar patterns were observed when comparing each designated focus area to other areas as well as to its corresponding municipality. Living in a high-risk neighborhood - defined by safety and livability - is associated with adverse birth outcomes. These findings highlight the need for place-based policy actions to reduce health disparities from the earliest stages of life. Future research will investigate whether local interventions in these specific neighborhoods contribute to improvements in perinatal health outcomes. ...

The first 1,000 days of life are a vital period for growth and development, with lasting effects on health and well-being. There is growing recognition of the importance of environmental and societal exposures, like the neighborhood a child is born into. This supports a ‘Health in All Policies’ approach, acknowledging that health is shaped by decisions beyond the healthcare sector. This study explores inequalities in perinatal health across high-risk neighborhoods in the Netherlands, as identified by the Dutch National Program on Safety and Livability (NLPV), focusing on the neighborhoods’ classification rather than their health outcomes. We used nationwide data from Perined (2015-2021) to compare perinatal outcomes among residents of 20 designated NLPV focus areas to other regions (n = 1,118,022 births). Outcomes included perinatal mortality (death from 24 weeks gestation to 7 days after birth), small for gestational age (birthweight <10th percentile), and preterm birth (before 37 weeks). A three-step logistic regression approach was applied: (1) comparing all focus areas combined to the rest of the country, (2) each focus area to the rest of the Netherlands, and (3) each to its municipality. Perinatal mortality (OR 1.13, 95% CI: 1.02-1.24), small for gestational age (OR 1.19, 95% CI: 1.16-1.21), and preterm birth (OR 1.09, 95% CI: 1.06-1.12) were all significantly more prevalent in designated focus areas compared to the rest of the Netherlands. Similar patterns were observed when comparing each designated focus area to other areas as well as to its corresponding municipality. Living in a high-risk neighborhood - defined by safety and livability - is associated with adverse birth outcomes. These findings highlight the need for place-based policy actions to reduce health disparities from the earliest stages of life. Future research will investigate whether local interventions in these specific neighborhoods contribute to improvements in perinatal health outcomes.

First in-human pilot study of wearable phototherapy for neonatal hyperbilirubinaemia

Journal article (2025) - Jessie Spaan, Jasper V. Been, Yanera Wallé, Irwin K.M. Reiss, Josephine H.L. Wagenaar, Christian V. Hulzebos, Berthe A.M. van der Geest

This pilot study aimed to assess the effectiveness and safety of the first wearable phototherapy device in (near-)term neonates with unconjugated hyperbilirubinaemia. This prospective single-arm intervention pilot study was conducted in the Erasmus MC Sophia Children’s Hospital maternity ward and the Primary Care Birth Centre Sophia in Rotterdam, the Netherlands. Twelve (near-)term neonates with hyperbilirubinaemia requiring treatment, according to the Dutch national hyperbilirubinaemia guideline, were treated with wearable phototherapy. Results were compared to a matched historical cohort of neonates treated with BiliSoft. Effective and safe treatment was defined by (1) the ability to discontinue phototherapy within 48 h after initiation and (2) no adverse events that necessitate switching to a conventional phototherapy device, as indicated by an independent expert. Twelve neonates were included, with a median gestational age of 38.5 weeks (IQR 37.9–39.2) and a median postnatal age of 77 h (IQR 58–87). In ten neonates (83%), phototherapy was successfully completed within 48 h, with a median phototherapy duration of 23 h (IQR 22.5–30.3) and a median TSB reduction rate of 1.8 µmol/L/h (IQR 2.3–1.1). These findings were similar in the control group. Two neonates were switched to conventional intensive phototherapy due to the ongoing rise of bilirubin levels despite wearable phototherapy treatment. No safety issues were recorded. Parents and healthcare providers reported positive experiences, highlighting benefits such as mobility and increased parental autonomy.

Conclusion: This pilot study provides data to indicate that wearable phototherapy is effective and safe in reducing bilirubin levels in the majority of (near-)term neonates with hyperbilirubinaemia. ...

Impact assessment of neonatal care interventions on regional neonatal care capacity

A simulation study based on clinical data in the Netherlands

Journal article (2025) - Josephine H.L. Wagenaar, Alexander Dietz, Yilin Huang, Irwin K.M. Reiss, Jasper V. Been, Jessie Spaan, René F. Kornelisse, Hendrik Rob Taal, Saba Hinrichs-Krapels

Objective To analyse the impact of selected neonatal care interventions on regional care capacity.Design Discrete event simulation modelling based on clinical data.

Setting Neonatal care in the southwest of the Netherlands, consisting of one tertiary-level neonatal intensive care unit (NICU), four hospitals with high-care neonatal (HCN) wards and six with medium-care neonatal (MCN) wards.

Participants 44 461 neonates admitted to at least one hospital within the specified region or admitted outside of the region but with a residential address inside the region between 2016 and 2021.

Interventions The impact of three interventions was simulated: (1) home-based phototherapy for hyperbilirubinaemia, (2) oral antibiotic switch for culture-negative early onset infection and (3) changing tertiary-level NICU admission guidelines.

Main outcome measure Regional neonatal capacity defined as: (1) occupancy per ward level, (2) required operational beds per ward level to provide care to all inside region patients at maximum 85% occupancy, (3) proportion rejected, defined as outside region transfers due to no capacity to provide local care and (4) the weekly rejections in relation to occupancy to provide a combined analysis.

Results In the current situation, with many operational beds closed due to nurse shortages, occupancy was extremely high at the NICU and HCNs (respectively 91.7% (95% CI 91.4 to 92.0) and 98.1% (95% CI 98.0 to 98.2)). The number of required beds exceeded available beds, resulting in >20% rejections for both NICU and HCN patients. Although the three interventions individually demonstrated effect on capacity, clinical impact was marginal. In combination, NICU occupancy was reduced below the 85% government recommendation at the cost of an increased burden for HCNs, highlighting the need for redistribution to MCNs.

Conclusion Our model confirmed the severity of current neonatal capacity strain and demonstrated the potential impact of three interventions on regional capacity. The model showed to be a low-cost and easy-to-use method for regional capacity impact assessment and could provide the basis for making informed decisions for other interventions and future scenarios, supporting data-driven neonatal capacity planning and policy development.

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Objective To analyse the impact of selected neonatal care interventions on regional care capacity.

Design Discrete event simulation modelling based on clinical data.

Setting Neonatal care in the southwest of the Netherlands, consisting of one tertiary-level neonatal intensive care unit (NICU), four hospitals with high-care neonatal (HCN) wards and six with medium-care neonatal (MCN) wards.

Participants 44 461 neonates admitted to at least one hospital within the specified region or admitted outside of the region but with a residential address inside the region between 2016 and 2021.

Interventions The impact of three interventions was simulated: (1) home-based phototherapy for hyperbilirubinaemia, (2) oral antibiotic switch for culture-negative early onset infection and (3) changing tertiary-level NICU admission guidelines.

Main outcome measure Regional neonatal capacity defined as: (1) occupancy per ward level, (2) required operational beds per ward level to provide care to all inside region patients at maximum 85% occupancy, (3) proportion rejected, defined as outside region transfers due to no capacity to provide local care and (4) the weekly rejections in relation to occupancy to provide a combined analysis.

Results In the current situation, with many operational beds closed due to nurse shortages, occupancy was extremely high at the NICU and HCNs (respectively 91.7% (95% CI 91.4 to 92.0) and 98.1% (95% CI 98.0 to 98.2)). The number of required beds exceeded available beds, resulting in >20% rejections for both NICU and HCN patients. Although the three interventions individually demonstrated effect on capacity, clinical impact was marginal. In combination, NICU occupancy was reduced below the 85% government recommendation at the cost of an increased burden for HCNs, highlighting the need for redistribution to MCNs.

Conclusion Our model confirmed the severity of current neonatal capacity strain and demonstrated the potential impact of three interventions on regional capacity. The model showed to be a low-cost and easy-to-use method for regional capacity impact assessment and could provide the basis for making informed decisions for other interventions and future scenarios, supporting data-driven neonatal capacity planning and policy development.

Introducing heart rate variability monitoring combined with biomarker screening into a level IV NICU

A prospective implementation study

Journal article (2022) - Şerife Kurul, Nicky van Ackeren , T.G. Goos, Christian R.B. Ramakers, Jasper V. Been, René F. Kornelisse, Irwin K.M. Reiss, Sinno H.P. Simons, H. Rob Taal

The aim of this study was to investigate the association between the implementation of a local heart rate variability (HRV) monitoring guideline combined with determination of inflammatory biomarkers and mortality, measures of sepsis severity, frequency of sepsis testing, and antibiotic usage, among very preterm neonates. In January 2018, a guideline was implemented for early detection of late-onset neonatal sepsis using HRV monitoring combined with determination of inflammatory biomarkers. Data on all patients admitted with a gestational age at birth of < 32 weeks were reviewed in the period January 2016–June 2020 (n = 1,135; n = 515 pre-implementation, n = 620 post-implementation). Outcomes of interest were (sepsis-related) mortality, sepsis severity (neonatal sequential organ failure assessment (nSOFA)), sepsis testing, and antibiotic usage. Differences before and after implementation of the guideline were assessed using logistic and linear regression analysis for binary and continuous outcomes respectively. All analyses were adjusted for gestational age and sex. Mortality within 10 days of a sepsis episode occurred in 39 (10.3%) and 34 (7.6%) episodes in the pre- and post-implementation period respectively (P = 0.13). The nSOFA course during a sepsis episode was significantly lower in the post-implementation group (P = 0.01). We observed significantly more blood tests for determination of inflammatory biomarkers, but no statistically significant difference in number of blood cultures drawn and in antibiotic usage between the two periods.Conclusion: Implementing HRV monitoring with determination of inflammatory biomarkers might help identify patients with sepsis sooner, resulting in reduced sepsis severity, without an increased use of antibiotics or number of blood cultures. ...