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An enquiry into the quality of care and its effect on the survival of babies born at 27–28 weeks
The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) devised Project 27/78 to identify the patterns of perinatal practice and service that may have affected the risk of a neonatal death between 27+0 and 28+6 weeks gestation. An executive summary is available on the CESDI website (www.cemach.org.uk). The report deals with perinatal care but this article concentrates on the key messages for neonatologists.
All babies with a gestational age at birth of 26–29+6 weeks born in England, Wales, and Northern Ireland between 1 September 1998 and 31 August 2000 were entered into special logbooks and data were collected on a standard proforma. A four weeks range was chosen to allow for inaccuracies in the estimation of gestational age at birth. The information from all neonatal deaths was compared with that from an equivalent number of babies who were selected at random from those who survived to 28 days after delivery. A multidisciplinary panel then audited predetermined aspects of perinatal care against a set of standards.1–4 Recommendations for future practice were derived using a Delphi consensus.
The Report has been appraised using the standards of the Royal College of Paediatrics and Child Health (RCPCH).5 There is no description of the original process by which the standards were developed. Project 27/28 complies with two of the three attributes for a clinical guideline. The rigour of the report shows appropriate composition of the guideline development group and scoping of the guideline. However there is a lack of a description of the search strategy used to identify evidence, quantification of the merits of the recommendations, and a link between the recommendations and the evidence base for them.