title: Neonatal Outcomes of Very Low Birth Weight and Very Preterm Neonates: An International Comparison.
abstract: To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes.
  
  
  
  We included 58 004 infants born weighing <1500 g at 24(0)-31(6) weeks' gestation from databases in Australia/New Zealand, Canada, Israel, Japan, Spain, Sweden, Switzerland, and the United Kingdom. We compared a composite outcome (mortality or any of grade ≥3 peri-intraventricular hemorrhage, periventricular echodensity/echolucency, bronchopulmonary dysplasia, or treated retinopathy of prematurity) between each country and all others by using standardized ratios and pairwise using logistic regression analyses.
  
  
  
  Despite differences in population coverage, included neonates were similar at baseline. Composite outcome rates varied from 26% to 42%. The overall mortality rate before discharge was 10% (range: 5% [Japan]-17% [Spain]). The standardized ratio (99% CIs) estimates for the composite outcome were significantly greater for Spain 1.09 (1.04-1.14) and the United Kingdom 1.16 (1.11-1.21), lower for Australia/New Zealand 0.93 (0.89-0.97), Japan 0.89 (0.86-0.93), Sweden 0.81 (0.73-0.90), and Switzerland 0.77 (0.69-0.87), and nonsignificant for Canada 1.04 (0.99-1.09) and Israel 1.00 (0.93-1.07). The adjusted odds of the composite outcome varied significantly in pairwise comparisons.
  
  
  
  We identified marked variations in neonatal outcomes between countries. Further collaboration and exploration is needed to reduce variations in population coverage, data collection, and case definitions. The goal would be to identify care practices and health care organizational factors, which has the potential to improve neonatal outcomes.
authors.affiliation: Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: pshah@mtsinai.on.ca.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.affiliation: Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia.
authors.forename: Kei
authors.initials: K
authors.lastname: Lui
authors.affiliation: Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sjörs
authors.affiliation: Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mirea
authors.affiliation: Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel.
authors.forename: Brian
authors.initials: B
authors.lastname: Reichman
authors.affiliation: Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Adams
authors.affiliation: UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, United Kingdom.
authors.forename: Neena
authors.initials: N
authors.lastname: Modi
authors.affiliation: Australia and New Zealand Neonatal Network, Department of Pediatrics, University of Otago, Christchurch, New Zealand.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Darlow
authors.affiliation: Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kusuda
authors.affiliation: Spanish Neonatal Network, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: San Feliciano
authors.affiliation: Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Junmin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
authors.forename: Stellan
authors.initials: S
authors.lastname: Håkansson
authors.affiliation: Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
authors.affiliation: Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bassler
authors.affiliation: Spanish Neonatal Network, Hospital Clinic, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Figueras-Aloy
authors.affiliation: Canadian Neonatal Network, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D005260:Female; D014943:Global Health; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality*; D019102:Infant, Very Low Birth Weight; D008297:Male; D012189:Retrospective Studies
keywords: bronchopulmonary dysplasia; composite outcome; peri-intraventricular hemorrhage; periventricular echodensity/echolucency; preterm birth; quality improvement; retinopathy of prematurity