title: Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study.
abstract: OBJECTIVE
  To explore international variations in the management and survival of extremely low gestational age and birthweight births.
  
  
  METHODS
  Area-based prospective cohort of births SETTING: 12 regions across Belgium, France, Italy, Portugal and the UK PARTICIPANTS: 1449 live births and fetal deaths between 22+0and 25+6weeks gestation born in 2011-2012.
  
  
  METHODS
  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%-70%) and at 24 weeks for those under 500 g (range 5%-71%). Antenatal steroids and provision of respiratory support at 22-24 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%-25%; 24 weeks range: 21%-50%), reflecting levels of treatment provision.
  
  
  CONCLUSIONS
  Wide international variation exists in the management and survival of extremely preterm births at 22-24 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.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Lucy K
authors.initials: LK
authors.lastname: Smith
authors.affiliation: Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm UMR 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Blondel
authors.affiliation: Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp and Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van Reempts
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Draper
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Manktelow
authors.affiliation: EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
authors.affiliation: Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
authors.affiliation: Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Inserm UMR 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D038622:Internationality; D050498:Live Birth / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011295:Prenatal Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data*
chemical_list: D005938:Glucocorticoids
keywords: Intensive Care; Neonatology; extremely premature infants; international perspectives; viability