{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:55:21Z","timestamp":1770749721410,"version":"3.50.0"},"reference-count":29,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/501100004963","name":"Seventh Framework Programme","doi-asserted-by":"publisher","award":["259882"],"award-info":[{"award-number":["259882"]}],"id":[{"id":"10.13039\/501100004963","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["CDF-2013-06-018"],"award-info":[{"award-number":["CDF-2013-06-018"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2017,1,16]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To explore international variations in the management and survival of extremely low gestational age and birthweight births.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Area-based prospective cohort of births<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>12 regions across Belgium, France, Italy, Portugal and the UK<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>1449 live births and fetal deaths between 22<jats:sup>+0<\/jats:sup> and 25<jats:sup>+6<\/jats:sup> weeks gestation born in 2011\u20132012.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with\/without severe morbidities).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The percentage of births recorded as live born was consistently low at 22\u2005weeks and consistently high at 25\u2005weeks but varied internationally at 23\u2005weeks for those weighing 500\u2005g and over (range 33%\u201370%) and at 24\u2005weeks for those under 500\u2005g (range 5%\u201371%). Antenatal steroids and provision of respiratory support at 22\u201324\u2005weeks gestation varied between countries, but were consistently high for babies born at 25\u2005weeks. Survival to discharge was universally poor at 22\u2005weeks gestation (0%) and at any gestation with birth weight &lt;500\u2005g, irrespective of treatment provision. In contrast, births at 23 and 24\u2005weeks weighing 500\u2005g and over showed significant international variation in survival (23 weeks: range: 0%\u201325%; 24\u2005weeks range: 21%\u201350%), reflecting levels of treatment provision.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Wide international variation exists in the management and survival of extremely preterm births at 22\u201324\u2005weeks gestation. Universally poor outcomes for babies at 22\u2005weeks and for those weighing under 500\u2005g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2016-312100","type":"journal-article","created":{"date-parts":[[2017,2,23]],"date-time":"2017-02-23T21:19:59Z","timestamp":1487884799000},"page":"F400-F408","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":48,"title":["Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study"],"prefix":"10.1136","volume":"102","author":[{"given":"Lucy K","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}]},{"given":"Beatrice","family":"Blondel","sequence":"additional","affiliation":[{"name":"Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epop\u00e9), Inserm UMR 1153, Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9, DHU Risks in pregnancy, Paris Descartes University, Paris, France"}]},{"given":"Patrick","family":"Van Reempts","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Antwerp University Hospital, University of Antwerp, Antwerp and Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium"}]},{"given":"Elizabeth S","family":"Draper","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}]},{"given":"Bradley N","family":"Manktelow","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}]},{"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[{"name":"EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal"}]},{"given":"Marina","family":"Cuttini","sequence":"additional","affiliation":[{"name":"Clinical Care and Management Innovation Research Area, Bambino Ges\u00f9 Children's Hospital, IRCCS, Rome, Italy"}]},{"given":"Jennifer","family":"Zeitlin","sequence":"additional","affiliation":[{"name":"Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epop\u00e9), Inserm UMR 1153, Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9, DHU Risks in pregnancy, Paris Descartes University, Paris, France"}]}],"member":"239","published-online":{"date-parts":[[2017,2,23]]},"reference":[{"key":"2025090221594210000_102.5.F400.1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1001\/jamapediatrics.2014.3362","article-title":"Keeping up with outcomes for infants born at extremely low gestational 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