title: Swiss medical centres vary significantly when it comes to outcomes of neonates with a very low gestational age.
abstract: OBJECTIVE
  This study quantified the impact of perinatal predictors and medical centre on the outcome of very low-gestational-age neonates (VLGANs) born at <32 completed weeks in Switzerland.
  
  
  METHODS
  Using prospectively collected data from a 10-year cohort of VLGANs, we developed logistic regression models for three different time points: delivery, NICU admission and seven days of age. The data predicted survival to discharge without severe neonatal morbidity, such as major brain injury, moderate or severe bronchopulmonary dysplasia, retinopathy of prematurity (≥stage three) or necrotising enterocolitis (≥stage three).
  
  
  RESULTS
  From 2002 to 2011, 6892 VLGANs were identified: 5854 (85%) of the live-born infants survived and 84% of the survivors did not have severe neonatal complications. Predictors for adverse outcome at delivery and on NICU admission were low gestational age, low birthweight, male sex, multiple birth, birth defects and lack of antenatal corticosteroids. Proven sepsis was an additional risk factor on day seven of life. The medical centre remained a statistically significant factor at all three time points after adjusting for perinatal predictors.
  
  
  CONCLUSIONS
  After adjusting for perinatal factors, the survival of Swiss VLGANs without severe neonatal morbidity was strongly influenced by the medical centre that treated them.
authors.affiliation: Division of Pediatric Critical Care, UCSF Medical Centre, San Francisco, CA, USA.
authors.forename: Martina A
authors.initials: MA
authors.lastname: Steurer
authors.affiliation: Department of Neonatology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Adams
authors.affiliation: Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.affiliation: Department of Neonatology, University Children's Hospital Basel, Basel, Switzerland.
authors.forename: Sven M
authors.initials: SM
authors.lastname: Schulzke
authors.affiliation: Clinic of Neonatology, University Hospital and University of Lausanne, Lausanne, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Roth-Kleiner
authors.affiliation: Neonatal and Paediatric Intensive Care Unit, Children's Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Berger
mesh_terms: D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology
keywords: Neonatal morbidity; Outcome variability; Perinatal predictors; Survival; Very low-gestational-age neonates