Rates of very preterm birth in Europe and neonatal mortality rates

Neonatal mortality rates are largely different between developed and developing countries. However, significant local differences exist between different developed countries or even within the same country. For instance, the UK Government highlighted in a recent survey that neonatal mortality rate in the UK is relatively higher than in other developed countries. This survey suggested also that immaturity might be recognised as the major cause of infant mortality.
Despite their heterogeneous nature, mortality rates are not usually sub-divided into more homogeneous categories, such as deaths related to immaturity, congenital anomalies, or sudden infant death. The lack of specific sub-categories leads to the identification only of some very general causes, like different health care delivery systems, to explain the differences in mortality.
A study assessing the influence of variation in the rate of very preterm delivery on the reported rate of neonatal death is therefore advocated. For this reason, some investigators from 10 European regions from 9 different countries conducted a prospective cohort study of all births that occurred between 22⁺⁰ and 31⁺⁶ weeks of gestation during 2003.
Results show that the region of Trent (UK) and of Northern UK had significantly higher rates of very preterm delivery per 1000 births (16.8 and 17.1, respectively) than the mean rate (13.2/1000 births). Four regions had rates significantly lower than the group average: Northern Portugal (10.7/1000), Eastern and Central Netherlands (10.6/1000), Eastern Denmark (11.2) and Lazio (Italy) [11.0/1000]. Similar trends were seen in live birth data. The official rates of neonatal death for each region were then adjusted by applying the rate of very preterm delivery and the existing death rate for babies born at this gestation in the individual region. The application of this standardization resulted in much greater homogeneity in terms of neonatal mortality, with the notable exception of UK. This finding may suggest that the variation in the rate of very preterm delivery has a major influence on reported neonatal death rates.
Some further and specific considerations may be added. For instance, the Netherlands has a high rate of neonatal death amongst live births at this gestation. This may be due to the national policy of not resuscitating babies born at = 25 weeks of gestation. Similarly, the situation of Poland is influenced by the decision of not terminating pregnancies with recognised major congenital anomalies and thus resulting in a greater proportion of lethal malformations. In contrast, it is worth highlighting that the German region of Hesse presented the highest rate of very preterm delivery, but the lowest rate of neonatal death. This strongly suggests that neonatal care strategies in Hesse may be very effective.
Taken together, the results of this observational study confirm the importance of preterm delivery rates in the evaluation of neonatal mortality rate. Since prematurity has major implications for individuals, families and society, this finding indicates the need for developed countries to establish accurately their rates of preterm delivery.

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