Online First articles may not be available until 09:00 (UK time) Friday.

Press releases Saturday 10 May 2008

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://bmj.com).

(1) No improvement in survival rates for extremely premature babies
(2) UNAIDS is out of touch with reality and should be closed down, says expert

(1) Research: Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000­5
BMJ Online First
(Editorial: Survival after extremely preterm birth)
BMJ Online First

In the week before the House of Commons is expected to debate the time limit on abortion in the UK, a study on bmj.com reports that over the past 12 years there has been no improvement in survival of babies born before 24 weeks' gestation, the current legal limit for abortion. The authors conclude that the limits of viability for the survival of premature babies have been reached.

It has been suggested that the current limit for abortion should be lowered because of continued improvements in the medical care and survival of premature babies. However, there is a lack of evidence to confirm whether survival of these babies has improved in recent years.

Professor David Field and colleagues from the University of Leicester examined the survival of all babies born before 26 weeks' gestation who were alive at the onset of labour, in the Trent health region of the UK, between 1994-9 and 2000-5. The study involved 16 hospitals with over 55 000 births a year.

The researchers found that despite over half the babies born at 23 weeks being admitted to intensive care, there was no improvement in survival in this group over the 12 years of the study, and only 18% (12/65) survived the stay in hospital.

Importantly, during the 12 year period, care for the 150 babies born at 22 weeks remained unsuccessful, and none survived to discharge.

However, the researchers report a significant improvement in the number of more mature preterm infants born at 24 and 25 weeks who survive to discharge. Of 497 babies admitted to intensive care in 2000-5, 236 (47%) survived to discharge compared with 174 of 490 (36%) in 1994-5.

The authors say that their findings cannot be explained by a change in obstetric or neonatal resuscitation practice as similar numbers died in the delivery room in both time periods. Of the infants born at 22 and 23 weeks, 58% (133/229) died in the delivery room in 1994-9 and 63% (126/200) in 2000-5.

The geographical region of Trent is reasonably representative of the UK as a whole, say the authors, and therefore the data is likely to similar to the outcomes of neonatal intensive care units across the UK.

The authors conclude that the limits of viability for the survival of premature babies have been reached.

The improved survival over time of more mature preterm infants shows how important it is to base decisions on the most up to date data possible, says an expert in an accompanying editorial.

Professor Neena Modi from Imperial College London, warns that factors other than gestational age-such as sex, exposure to antenatal steroids, single or multiple birth, and birth weight- can influence survival and health outcomes.

Directives on the care that should be offered to extremely preterm babies should not be based solely on gestational age, she concludes.

Contact:
Professor David Field, Neonatal Unit, Leicester Royal Infirmary, Leicester, UK
Email: david.field@uhl-tr.nhs.uk

Editorial: Neena Modi, Professor of Neonatal Medicine, Imperial College London, UK
Email: n.modi@imperial.ac.uk

(2) UNAIDS is out of touch with reality and should be closed down, says expert
(Personal view: The writing is on the wall for UNAIDS)
http://www.bmj.com/cgi/content/short/336/7652/1072

The exclusive focus on HIV promoted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) is damaging health systems and distorting health financing, and UNAIDS should be closed down immediately, writes an expert in this week's BMJ.

We are spending far too much on HIV relative to other health needs, writes Roger England, Chairman of the Health Systems Network. Some of the money would be better spent on strengthening general health services and funding more effective interventions in other diseases such as pneumonia and diabetes that kill more people, he adds.

Globally HIV causes 3.7% of mortality, yet receives 25% of health aid and a big proportion of domestic expenditure.

But HIV has not been the global catastrophe that was predicted, he says, in fact global HIV deaths are about the same as deaths of under fives in India.

"With its own UN agency, HIV has been treated like an economic sector rather than a disease," claims England.

Billions of pounds have been wasted by national AIDS commissions and in funding obscure disciplines and projects instead of strengthening public health systems in developing countries that could have controlled transmission, he argues.

In addition, excessive HIV aid has created parallel financing, employment and organisational structures that have weakened national health systems and sidelined much needed structural reform, he says. Furthermore, off-budget HIV-dedicated funding provides no incentives for sustainable country systems, achieves poor value for money, and increases aid dependency.

He believes that only 10% of the US$10bn a year dedicated to HIV is needed for the 2 million people now receiving free treatment. Switching the rest of the HIV funding to general health budgets would make a huge difference to developing country health systems allowing them to prioritise and improve the way they deal with prevention and treatment of a range of diseases.

A UN agency dedicated to a single disease is a liability, and UNAIDS needs to be closed down, concludes England: "not because it has performed badly given its mandate - but because its mandate was wrong and harmful. Its technical functions should be re-fitted into WHO, to be balanced with those of other diseases."

Contact:
Roger England, Chairman, Health Systems Workshop, Grenada, West Indies
Email: roger.england@healthsystemsworkshop.org

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs Division, BMA House, Tavistock Square London WC1H 9JR

(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)