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Extremely low gestational age neonates (ELGANs) are probably the most vulnerable of all patient groups. Caring for these infants requires specialised services with a good infrastructure, dedication of the entire team and experience. Numerous studies have shown that perinatal outcomes are better in large centres providing the highest level of care compared to smaller ones or those working in a less experienced or lower level setting.1 Nonetheless, drawing practical conclusions from these data, namely to rigorously centralise perinatal care, meets resistance, in the UK and abroad. Or how else can the recent findings by Marlow et al, reported in this issue, be explained? They found that only 56% of ELGANs were born in hospitals providing the highest level of perinatal care.2 This low rate cannot be due to biology or distance: in Finland, for example, a country with an area 1.5 times that of the UK, provision of the highest level neonatal care is concentrated to only 5 centres, with many patients having long distances to …
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