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Survival after very preterm birth has increased across the developed world, but a consistent theme to emerge in published studies is that the increase in survival may come at the cost of increased morbidity.1,–,3 Hack and Fanaroff4 summarised the predominantly North American experience from the 1990s and concluded that costs of salvaging ever more immature babies were beginning to outweigh the benefits. Their data are predominantly based on birth weight rather than gestation, are derived from heterogeneous populations (unit based, regional) and reflect the situation in a healthcare system (in the USA) in which the provision of tertiary neonatal care has become steadily more regionalised since the 1970s.5 Regionalisation of perinatal care in Europe is less developed and the demographics and models of care delivery vary between the different European countries.6 7 This article is an attempt to draw together the European literature on population-based outcomes of very preterm babies from the past 25 years.
A literature search was carried out on MEDLINE and EMBASE databases for all studies citing outcomes of preterm populations over the past 30 years. Studies that referred to cohorts that were not population based (for this purpose one confined to a defined geographical region or country) were excluded. Articles cited in the retrieved literature and not identified by other means were located separately. In addition, reference was made to the author's own collected literature and through direct correspondence with two of the authors.
A total of 29 population-based studies published since 1986 relating to cohorts born between 1983 and 2006 were identified; 13 studies reported survival outcomes only8,–,19 (table 1); 12 reported developmental …
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