We agree with Page and Rafi about the importance of identifying the key evidence based obstetric and neonatal interventions that can be monitored to assess quality of care for very preterm infants.1 2 As our study shows,3 evaluating the use and impact of four evidence based practices together sets higher standards and focuses attention on care processes. The EPICE (Effective Perinatal Intensive Care in Europe) project’s international dimension is a strength, as it reveals underuse of evidence based care in many health systems and cultures. But international …