The mortality of CDH when complete case ascertainment is achieved is unaffected by new therapies. The survival rate is principally determined by the rate of antenatal termination and the incidence of associated anomalies. Reports of improved survival of CDH should be interpreted with caution, as variations in outcome are more likely to be explained by case selection artifact.

Background: Previous data from this unit suggest that postnatal growth retardation (PGR) is inevitable in preterm infants. However, the study was performed in a single level III neonatal intensive care unit and applicability of the findings to other level III or level I-II special care baby units was uncertain. Objectives: To examine postnatal hospital growth and to compare growth outcome in preterm infants discharged from four level III tertiary care units and 10 level I-II special care baby units in the former Northern Region of the United Kingdom. Subjects/methods: Preterm infants (( 32 weeks gestation; ( 1500 g) surviving to discharge were studied. Infants were weighed at birth and discharge. Body weight was converted into a z score using the British Foundation Growth Standards. To ascertain the degree of PGR, the z score at birth was subtracted from the z score at discharge. Data were evaluated using a combination of split plot (level III v I-II = main factor; individual centre = subfactor) and stepwise regression analyses. Results were considered significant at p , 0.05. Results: A total of 659 (level III, n = 335; level I-II, n = 324) infants were admitted over a 24 month period (January 1998-December 1999. No differences were detected in birth characteristics, CRIB score (a measure of illness in the first 24 hours of life), length of hospital stay, weight gain, weight at discharge, or degree of PGR between infants discharged from level III and level I-II units. Significant variation was noted in length of hospital stay (,35%; p , 0.001), weight gain (,33%; p , 0.001), weight at discharge (,20%; p , 0.001), and degree of PGR (,200%; p , 0.001) between the level III units. Even greater variability was noted in the duration of hospital stay (,40%; p , 0.001), weight gain (,60%; p , 0.001), weight at discharge (,40%, p , 0.001), and degree of PGR (,300%, p , 0.001) between the level I-II units. Conclusions: These data stress the variable but universal nature of PGR in preterm infants discharged from level III and I-II neonatal intensive care units and raise important questions about nutritional support of these infants before and after hospital discharge.

Objective: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe. Design: A prospective birth cohort of very preterm infants for 10 geographically defined European regions during 2003, followed to discharge home from hospital. Participants: All deliveries from 22 + 0 to 31 + 6 weeks' gestation. Main outcome measure: All outcomes of pregnancy by gestational age group, including termination of pregnancy for congenital anomalies and other reasons, antepartum stillbirth, intrapartum stillbirth, labour ward death, death after admission to a neonatal intensive care unit (NICU) and survival to discharge. Results: Overall the proportion of this very preterm cohort who survived to discharge from neonatal care was 89.5%, varying from 93.2% to 74.8% across the regions. Less than 2% of infants ,24 weeks' gestation and approximately half of the infants from 24 to 27 weeks' gestation survived to discharge home from the NICU. However large variations were seen in the timing of the deaths by region. Among all fetuses alive at onset of labour of 24-27 weeks' gestation, between 84.0% and 98.9% were born alive and between 64.6% and 97.8% were admitted to the NICU. For babies ,24 weeks' gestation, between 0% and 79.6% of babies alive at onset of labour were admitted to neonatal intensive care. Conclusions: There are wide variations in the survival rates to discharge from neonatal intensive care for very preterm deliveries and in the timing of death across the MOSAIC regions. In order to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm infants analysing the cohort by gestational age band.Although the validity of direct comparisons of perinatal and neonatal mortality rates and their contributions to overall survival has been questioned, these figures are still routinely produced and attract often sensational media headlines. The problems associated with the collection of these data in terms of differences in definitions, registration and delivery policies (which may reflect differences in ethical attitude), have been highlighted in many publications.

Evidence of prolongation of intensive care and increased costs of such care, without clear beneficial effects, implies that iNO cannot be recommended for preterm infants with severe hypoxic respiratory failure.