Regionalized long-term follow-up

The importance of population-based long-term follow-up studies of geographically determined cohorts to evaluate the effectiveness, efficiency and availability of a regionalized perinatal–neonatal care programme is demonstrated by the Victorian Infant Collaborative Study Group. The survival and quality of survival of consecutively born extremely-low-birthweight infants below 1000 g or extremely preterm infants below 28 weeks' gestation in the state of Victoria were assessed up to 14 years of age over four distinctive eras: 1979–1989, 1985–1987, 1991–1992 and 1997. Both survival and quality-adjusted survival rates rose progressively in all birth weight and gestation subgroups, associated with progressively more such infants being born in level III perinatal centres. Cost–effectiveness and cost–utility ratios remained stable overall, with efficiency gains in the smaller infants over time. Regionalized long-term follow-up provides unique information that is not available from institution-based studies, which is vital to the regional organization of perinatal–neonatal care.