• neonatology
• neurodevelopment
• epidemiology

Draper and colleagues present the results of their international, multicentre outcomes study of very preterm (VPT) infants.1 The study was performed in 11 of 19 centres participating in the Effective Perinatal Intensive Care in Europe (EPICE) collaboration. Study participants include infants born between 22 0/7 and 31 6/7 weeks in 2011 and 2012. The primary outcome measure was rate of moderate or severe neurodevelopmental impairment (NDI) using a parent report tool at 2 years of age. There was a high overall rate of moderate or severe NDI and a high degree of variability in rates of NDI between countries, even after adjusting for maternal and infant factors.

Understanding and identifying sources of variability in the outcomes of VPT infants are important for guiding neonatal care and decision-making. The authors are to be commended for their international and interinstitutional approach to understanding outcomes and their predictors. Harmonising outcomes measures across centres and countries is no easy feat.

This paper highlights an important and understudied problem in maternal and child health: regional variation in outcomes and the role of geography in determining health status. Much has been written about health disparities between rich and poor countries, with differences in disease prevalence and outcomes attributed to lack of medical services, poor sanitation and hygiene, and the scourge of poverty itself.2 But what about differences between middle-income and …