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Draper et al1 have highlighted the variation across Europe in outcomes of very preterm infants. Specifically, at 24–27 weeks' gestation, mortality as a percentage of infants alive at start of labour varied from 41.5% to 80.5%, and at <24 weeks' gestation from 0% to 9.7%. There is no mention, however, of the potential for variation within regions.
We have recently audited the outcome for extremely preterm babies born alive within the city of Glasgow between 1 January 1998 and 31 December 2002. The 3 maternity units serve a population of approximately 750 000 and delivered on average a total of just more than 11 000 infants per annum. In all, 130 live births between 23+0 and 25+6 weeks' gestation were documented over the 5-year period. The survival of one infant could not be determined, and was thus excluded from the analysis. Survival rates were comparable to EPICure2 for infants born between 24 and 25+6 weeks' gestation, but tended to be poorer for infants born <24 weeks (n=24), of whom none survived (EPICure survival to discharge 11%, p=0.073)
The number of recorded live births <26 weeks' gestation as a percentage of total live births varied between the 3 maternity units from 8 to 11 per 10 000 live births, and there were significant differences in terms of survival to discharge (table 1). Data regarding neurological status at discharge from hospital follow-up (generally at around 2 years) were available for 83% of survivors: survival free of major disability was similar for hospitals 1 and 2 but higher than for hospital 3. For hospitals 1 and 2 major disability-free survival was comparable to that reported among infants of 24−25+6 weeks' gestation in the EPICure cohort.2
These data highlight the fact that there may be significant differences in survival of extremely preterm infants between maternity and neonatal units, even within the same city. Differences in survival may represent different practices within the labour ward as well as the neonatal unit, and are of course influenced by many factors including social demographics. Outcome data should include neurological status as well as survival to discharge.
Competing interests: None.
Provenance and peer review: Not commissioned; not externally peer reviewed.
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