Introduction

Survival after very preterm birth has increased across the developed world, but a consistent theme to emerge in published studies is that the increase in survival may come at the cost of increased morbidity.1,–,3 Hack and Fanaroff4 summarised the predominantly North American experience from the 1990s and concluded that costs of salvaging ever more immature babies were beginning to outweigh the benefits. Their data are predominantly based on birth weight rather than gestation, are derived from heterogeneous populations (unit based, regional) and reflect the situation in a healthcare system (in the USA) in which the provision of tertiary neonatal care has become steadily more regionalised since the 1970s.5 Regionalisation of perinatal care in Europe is less developed and the demographics and models of care delivery vary between the different European countries.6 7 This article is an attempt to draw together the European literature on population-based outcomes of very preterm babies from the past 25 years.