The hard problem

The survival of extremely preterm infants (<26 gestational weeks) has increased considerably during the last decades. In a national study from the United Kingdom and Ireland, all of these tiny infants born in 1995 have been followed up (EPICure). Of these infants, 46% were found to be severely or moderately disabled at 30 months (1). There is a concern that the improved survival of extremely preterm infants will increase the incidence of adverse neurodevelopmental outcome. In this issue, Wyatt et al. at the University College London report a progressive survival of these infants from 32% to 71% between 1981 and 2000 (2). In spite of these excellent survival results, there was no increase of impairment leading to disability (2). Two Swedish studies have also reported less neurological complications than the British National Survey (3,4). However, even if more severe cerebral complications such as severe intraventricular haemorrhage (IVH) or white matter injury with cysts can be avoided, there is still a risk for