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.