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Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study
Lucy K Smith, Beatrice Blondel, Patrick Van Reempts, Elizabeth S Draper, Bradley N Manktelow, Henrique Barros, Marina Cuttini, Jennifer Zeitlin, for the EPICE Research Group
Arch Dis Child Fetal Neonatal Ed. (2017)

As a result of improved antenatal and neonatal care, survival has increased for infants born at the limits of viability, however not without risk of severe morbidities. Counselling parents and making decisions about treatments for these infants is difficult, as survival rates vary widely. The aim was to explore international variations in the management and survival of extremely low gestational age and birthweight births in the EPICE regions of Belgium, France, Italy, Portugal and the UK.

International variation was seen in the proportion of births recorded as live born, which could be due to real differences in live births but is likely to reflect differences in the criteria used for defining viability. Live births were consistently low at 22 weeks and high at 25 weeks but varied across countries at 23 and 24 weeks of gestation. Differences were also seen in management and survival. Antenatal steroid use and respiratory support was high for infants born at 25 weeks but varied between countries for births at 22-24 weeks. Rates of respiratory support were consistently higher in Italy and lowest in France. Survival to discharge was poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, regardless of initiation of active treatment. Infants born at 23 and 24 weeks weighing 500 g and over had varying survival rates depending on country, reflecting levels of treatment provision. Survival was generally higher in countries with higher rates of respiratory support initiation and antenatal steroid provision.

As there may be little impact of interventions and support for infants born at 22 weeks or weighing under 500g, the results support a higher threshold of 23 weeks of gestational age and introducing a birth weight threshold in ethical decision-making.

See article here: Arch Dis Child Fetal Neonatal Ed. (2017)