The data presented by Rattihalli et al1 on the evolution of health outcomes for babies born before 26 weeks gestation in the Trent region show rising survival rates (27–46%) between 1991–1993 and 2001–2003 accompanied by a slightly increased probability of severe disability among survivors (35–39%). These results raise multiple questions: Why were there such large gains in survival but no improvement in impairment rates? Can these results be used to draw conclusions about trends in outcome in other regions of Europe or in the USA? How can these data be used to guide clinical decisions for these infants whose probability of being severely disabled is over 1 in 3? Trying to contextualise these findings using the available scientific literature is daunting. There is co...