Compare and contrast: France, Switzerland and Holland

This month we have papers from three different countries, each addressing separate but related aspects of management and survival of extremely preterm babies, together with an Editorial. Reading these papers together illuminates some of the fundamental difficulties in modern neonatal care: the counselling of parents where extremely preterm or ‘periviable' delivery appears likely, the nature of the care given in the delivery room, and the underlying factors that modulate both the conversations with the parents and the nature of the care given. The main underlying factor is the likely survival and probability of disability in very preterm infants, which influences both parental attitude and physician behaviour, but may not be based on the most up to date information. Perlbarg et al, reporting from the French Epipage-2 study, found that although many factors other than gestational age relate to outcomes, in reality it was gestational age that overwhelmingly determined delivery room management. It is well known that attitudes to extremely preterm birth have changed substantially in Holland over recent years, and this change is unpicked by Zegers et al. They make a persuasive …