Neonatal morbi-mortality in very low birth weight in Europe: the Portuguese experience.

The aim of this study was to access evolution in care of very low birth weight (VLBW) infants after the implementation of a regionalization policy in Portugal. The data of the National Portuguese Network of VLBW infants are analyzed concerning mortality, morbidity, and quality of regionalization. A total of 12,826 VLBW infants born from 1 January 1994 to 31 December 2008 were enrolled, with a prevalence of 0.66%-0.99% of all live born. The global mortality was 11%. The major improvement in survival is in the babies more than 1000 g. Since 2004, the threshold of viability is 25 weeks, but the intact survival is around 28 weeks. In the last 10 years with more efficient regionalization more VLBW babies are born in the right place. The improvement in neonatal mortality rate was determinant in the good evolution of perinatal and infant mortalities. After reinforcement of regionalization policies, we found improvements in mortality for VLBW infants. The aims of regionalization were achieved. The reform of perinatal care in Portugal is an example of how a good diagnosis and adequate proposals combined with a strong political will is crucial for changing.