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Investigating the variations in survival rates for very preterm infants in 10 European regions: the MOSAIC birth cohort
  1. E S Draper1,
  2. J Zeitlin2,
  3. A C Fenton3,
  4. T Weber4,
  5. J Gerrits5,
  6. G Martens6,
  7. B Misselwitz7,
  8. G Breart2,
  9. on behalf of the MOSAIC research group
  1. 1
    Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2
    INSERM, UMR S149, Epidemiological Research Unit on Perinatal and Women’s Health, Paris, France
  3. 3
    Department of Neonatology, Royal Victoria Infirmary, Newcastle, UK
  4. 4
    Department of Obstetrics and Department of Paediatrics, Hvidovre University Hospital, Denmark
  5. 5
    Department of Paediatrics, University Medical Centre Children’s Hospital, Nijmegen, the Netherlands
  6. 6
    Study Centre for Perinatal Epidemiology, Brussels, Belgium
  7. 7
    Institute of Quality Assurance, Eschborn, Germany
  1. Elizabeth S Draper, Department of Health Sciences, University of Leicester, 22–28, Princess Road West, Leicester LE1 6TP, UK; msn{at}


Objective: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe.

Design: A prospective birth cohort of very preterm infants for 10 geographically defined European regions during 2003, followed to discharge home from hospital.

Participants: All deliveries from 22 + 0 to 31 + 6 weeks’ gestation.

Main outcome measure: All outcomes of pregnancy by gestational age group, including termination of pregnancy for congenital anomalies and other reasons, antepartum stillbirth, intrapartum stillbirth, labour ward death, death after admission to a neonatal intensive care unit (NICU) and survival to discharge.

Results: Overall the proportion of this very preterm cohort who survived to discharge from neonatal care was 89.5%, varying from 93.2% to 74.8% across the regions. Less than 2% of infants <24 weeks’ gestation and approximately half of the infants from 24 to 27 weeks’ gestation survived to discharge home from the NICU. However large variations were seen in the timing of the deaths by region. Among all fetuses alive at onset of labour of 24–27 weeks’ gestation, between 84.0% and 98.9% were born alive and between 64.6% and 97.8% were admitted to the NICU. For babies <24 weeks’ gestation, between 0% and 79.6% of babies alive at onset of labour were admitted to neonatal intensive care.

Conclusions: There are wide variations in the survival rates to discharge from neonatal intensive care for very preterm deliveries and in the timing of death across the MOSAIC regions. In order to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm infants analysing the cohort by gestational age band.

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  • Funding: This project was partially funded by a grant from the European Commission Research Directorate (QLG4-CT-2001-01907) and coordinated by Assitance Publique-Hôpitaux de Paris. The MOSAIC research group maintained complete independence from the funding body in relation to the research process and reporting of results. The authors would like to acknowledge the assistance of the personnel in the maternity and neonatal units in the regions participating in the MOSAIC project.

  • Competing interests: None.

  • Ethics approval: Ethics approval was sought for the collection of these data as required in each of the regions.

  • Contributors: The conception and design of article were developed by the listed authors. Analysis and interpretation of the data were carried out by ESD and JZ. ESD wrote the first draft of the paper and all authors participated in revisions and approved the final manuscript. ESD is the guarantor.

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