{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T01:11:26Z","timestamp":1770513086552,"version":"3.49.0"},"reference-count":38,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100011104","name":"Fifth Framework Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011104","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":[[2017,11,27]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Area-based cohort study of all births before 32 weeks of gestational age.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>16 regions in 11 European countries in 2011\/2012.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Survivors to discharge from neonatal care (n=6422).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades \u22653. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%\u201323.5%) and 13.8% including severe BPD (regional range 10.0%\u201323.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%\u201318.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P&lt;0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/archdischild-2017-313697","type":"journal-article","created":{"date-parts":[[2018,1,20]],"date-time":"2018-01-20T12:20:26Z","timestamp":1516450826000},"page":"F36-F45","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["Wide variation in severe neonatal morbidity among very preterm infants in European regions"],"prefix":"10.1136","volume":"104","author":[{"given":"Anna Karin","family":"Edstedt Bonamy","sequence":"first","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institute, Stockholm, Sweden"},{"name":"Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9568-2969","authenticated-orcid":false,"given":"Jennifer","family":"Zeitlin","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epop\u00e9), Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9, DHU Risks in pregnancy, Paris Descartes, Paris, France"}]},{"given":"Aur\u00e9lie","family":"Piedvache","sequence":"additional","affiliation":[{"name":"Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epop\u00e9), Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9, DHU Risks in pregnancy, Paris Descartes, Paris, France"}]},{"given":"Rolf F","family":"Maier","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany"}]},{"given":"Arno","family":"van Heijst","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands"}]},{"given":"Heili","family":"Varendi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Tartu, Tartu University Hospital, Tartu, Estonia"}]},{"given":"Bradley N","family":"Manktelow","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}]},{"given":"Alan","family":"Fenton","sequence":"additional","affiliation":[{"name":"Newcastle University, Newcastle upon Tyne, UK"}]},{"given":"Jan","family":"Mazela","sequence":"additional","affiliation":[{"name":"Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Ges\u00f9 Children\u2019s Hospital, Institute for Research and Health Care, Rome, Italy"}]},{"given":"Marina","family":"Cuttini","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland"}]},{"given":"Mikael","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden"}]},{"given":"Stavros","family":"Petrou","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK"}]},{"given":"Patrick Van","family":"Reempts","sequence":"additional","affiliation":[{"name":"Department of Neonatolog, Antwerp University Hospital, University of Antwerp, Antwerp and Study Centre for Perinatal Epidemiology Flanders, Belgium, Europe"}]},{"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[{"name":"EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal"}]},{"given":"Elizabeth S","family":"Draper","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Leicester, Leicester, UK"}]}],"member":"239","published-online":{"date-parts":[[2018,1,20]]},"reference":[{"key":"2025090512350574000_104.1.F36.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60820-4"},{"key":"2025090512350574000_104.1.F36.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1410689"},{"key":"2025090512350574000_104.1.F36.3","doi-asserted-by":"publisher","DOI":"10.1136\/fetalneonatal-2011-301572"},{"key":"2025090512350574000_104.1.F36.4","first-page":"2225-33","article-title":"One-year survival of extremely preterm infants after active perinatal care in 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