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Evaluating and comparing neonatal outcomes
  1. Elizabeth S Draper
  1. Correspondence to Professor Elizabeth S Draper, University of Leicester, Department of Health Sciences, 22-28 Princess Road West, Leicester LE1 6TP, UK; msn{at}le.ac.uk

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Although it is generally accepted that a standardised approach to the collection of perinatal and neonatal data is required, definitions of the most straightforward outcomes such as perinatal and neonatal mortality still vary across the developed world. As such the wide variations seen in neonatal outcomes may be attributable to external influences—for example, differences in definition, ascertainment levels and registration as well as hospital policies regarding delivery and neonatal unit admission, particularly around the limits of viability.1,,5 The evaluation and comparison of neonatal outcomes are used for the clinical governance and performance management of neonatal medicine at many levels: from local to national and international comparisons. Ensuring true ‘like for like’ comparison is therefore of utmost importance.

New development of outcome measures

The EURO-PERISTAT project resulted from a recognition of the current limitations of the routine statistics produced across Europe.6 7 The aim of the project was to develop valid and reliable indicators for the monitoring and evaluation of perinatal health across the EU and involved 25 member states and Norway. National routine statistics were developed at a time when the majority of perinatal and neonatal deaths were of mature infants and associated with infection, poor maternal health and limited care provision. Nowadays, the main factor affecting neonatal survival is preterm delivery8 and, as such, comparative indicators should reflect this and be flexible enough to allow for the appropriate selection of birth cohorts to answer specific questions. In its latest report9 EURO-PERISTAT proposes a new approach for the reporting based on multiple indicators concerning outcomes, healthcare factors and other factors affecting pregnancy outcomes. However, much work is required across Europe to achieve this aim including the standardisation of birth and death notification or registration systems to include all births from 22 weeks' gestational age (including terminations of …

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