@article {SmithF400, author = {Lucy K Smith and Beatrice Blondel and Patrick Van Reempts and Elizabeth S Draper and Bradley N Manktelow and Henrique Barros and Marina Cuttini and Jennifer Zeitlin}, editor = {, and , and Martens, E and Martens, G and Van Reempts, P and Boerch, K and Hasselager, A and Huusom, L and Pryds, O and Weber, T and Toome, L and Varendi, H and Ancel, PY and Blondel, B and Burguet, A and Jarreau, PH and Truffert, P and Maier, RF and Misselwitz, B and Schmidt, S and Gortner, L and Baronciani, D and Gargano, G and Agostino, R and DiLallo, D and Franco, F and Carnielli, V and Cuttini, M and Koopman-Esseboom, C and van Heijst, A and Nijman, J and Gadzinowski, J and Mazela, J and Gra{\c c}a, LM and Machado, MC and Rodrigues, Carina and Rodrigues, T and Bonamy, AK and Norman, M and Wilson, E and Boyle, E and Draper, ES and Manktelow, BN and Fenton, AC and Milligan, DWA and Zeitlin, J and Bonet, M and Piedvache, A}, title = {Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study}, volume = {102}, number = {5}, pages = {F400--F408}, year = {2017}, doi = {10.1136/archdischild-2016-312100}, publisher = {BMJ Publishing Group}, abstract = {Objective To explore international variations in the management and survival of extremely low gestational age and birthweight births.Design Area-based prospective cohort of birthsSetting 12 regions across Belgium, France, Italy, Portugal and the UKParticipants 1449 live births and fetal deaths between 22+0 and 25+6 weeks gestation born in 2011{\textendash}2012.Main outcome measures Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities).Results The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33\%{\textendash}70\%) and at 24 weeks for those under 500 g (range 5\%{\textendash}71\%). Antenatal steroids and provision of respiratory support at 22{\textendash}24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0\%) and at any gestation with birth weight \<500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0\%{\textendash}25\%; 24 weeks range: 21\%{\textendash}50\%), reflecting levels of treatment provision.Conclusions Wide international variation exists in the management and survival of extremely preterm births at 22{\textendash}24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/102/5/F400}, eprint = {https://fn.bmj.com/content/102/5/F400.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }