Variation in practice and poor outcomes for extremely preterm infants

It’s alarming that the treatment that families can expect when threatened with extremely preterm birth varies enormously and the likelihood of their baby surviving to discharge is determined by a great many additional influences other than medical circumstance. But how many families know that? Caroline Diguisto et al report an analysis of the outcome of infants born before 25 weeks gestation in France derived from the EPIPAGE2 cohort study. Regional rates for the provision of active antenatal care (antenatal corticosteroids or magnesium sulfate or caesarean delivery) varied from 21% to 61%. Differences remained significant after adjustment for individual and organisational characteristics. There was wide variation in the number of infants born alive who died in the delivery room. The authors conclude that the dependence of life and death decisions on place of birth raises serious ethical questions. In an accompanying editorial Annie Janvier and colleagues develop this theme further, with additional examples from the UK and the USA and with the evidence linking outcomes to unit activity. There remains an alarming proportion of extremely preterm infants born in the UK …