Article Text

  1. E S Draper1,
  2. D J Field1,
  3. A Fenton2,
  4. E Papiernik3,
  5. J Zeitlin3,
  6. B Blondel3,
  7. M Cuttini4,
  8. R Maier5,
  9. T Weber6,
  10. M Carrapato7,
  11. L Kollee8,
  12. J Gadzin9,
  13. P van Reempts10
  1. 1Department of Health Sciences, University of Leicester, Leicester, UK,
  2. 2Department of Neonatology, RVI, Newcastle, UK,
  3. 3Inserme, UMR S149, Paris, France,
  4. 4Unit of Epidemiology, Ospedale Pediatric Bambino Gesu, Rome, Italy,
  5. 5Department of Neonatology, University Hospital, Marburg, Germany,
  6. 6Departments of Pediatrics and Obstetrics, Hvidore University Hospital, Copenhagen, Denmark,
  7. 7Department of Pediatrics, Sao Sebastio, Sta Maria de Feira, Portugal,
  8. 8Department of Paediatrics, University Medical Centre Children’s Hospital, Nijmegen, The Netherlands,
  9. 9Department of Neonatology, University of Medical Sciences, Poznan, Poland,
  10. 10Department of Neonatology, University of Antwerpen, Antwerpen, Belgium


Background: Wide variations are seen in published neonatal death rates across Europe.

Objective: To estimate the influence of variation in the rate of very preterm birth (VPTB) on reported rates of neonatal death (NND) in 10 European regions.

Method: A cohort study was established to collect data for all births between 22 + 0 and 31 + 6 weeks of gestation in 2003 for 10 geographically defined European populations from nine countries. Published rates of NND for each region were then adjusted by applying a standardised rate of VPTB across all regions and the existing NND rate for babies born at this gestation in the individual region.

Results: Two regions had significantly higher rates of VPTB per 1000 births (Trent UK (16.8, 95% CI 15.7 to 17.9) and northern UK (17.1, 95% CI 15.6 to 18.6); overall MOSAIC region mean 13.2, 95% CI 12.9 to 13.5). There were significantly low rates in four regions: the lowest being eastern/central Netherlands (10.6, 95% CI 9.7 to 11.6). Adjusted NND rates showed greater homogeneity in terms of neonatal mortality with neither UK region being statistically different to the group mean. The German region of Hesse, despite a high rate of VPTB, had the lowest NND rate before and after adjustment.

Conclusions: Variation in the rate of VPTB has a major influence on reported NND rates. Understanding the influences on rates of VPTB should be a priority in view of the high cost of caring for these infants both acutely and in the longer term.

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