Assessing the Effectiveness of Care for Very Low Birth Weight Infants—Do We Really Need Population-Based Data?

The active and vigorous care now provided for even the smallest infants has reduced both mortality and morbidity among very low birth weight (VLBW, birth weight <1500 g) infants. The efficacy of individual therapeutic elements has been documented as a part of this management, in some cases by randomized controlled clinical trials. Thus the present practices of providing respiratory, nutritional, and environmental support for VLBW infants seem to be well supported by experimental evidence, usually derived from large hospital-based experience. What—if any—additional information can be gained by relating the outcome of VLBW infants to geographic data covering all such births? In the present commentary, an attempt is made to answer this question by focusing first on two important aspects, namely, the availability and overall effectiveness of intensive care services for VLBW infants.