Changing patterns in regionalization of perinatal care and the impact on neonatal mortality.
Yeast, John D. MD; Poskin, Mary MSN; Stockbauer, Joseph W. MA; Shaffer, Stanley MD
[Miscellaneous Article]
American Journal of Obstetrics & Gynecology.
178(1):131-135, January 1998.
(Format: HTML)
OBJECTIVE: Our goal was to study changing patterns of low-birth-weight outcome over the past decade as deregionalized perinatal care has occurred.
STUDY DESIGN: Live births and neonatal mortality for two 5-year periods (1982 to 1986 vs 1990 to 1994) were calculated by hospital of delivery in the state of Missouri. Self-designated level of perinatal care was contrasted with number of deliveries and nursery census to evaluate outcome. Regression models were constructed to compare outcome between levels of care.
RESULTS: There has been a significant shift of deliveries into self-designated level II and III perinatal centers. However, this is largely a result of redesignation of care rather than an actual increase in acuity or census. The relative risk of neonatal mortality for very-low-birth-weight infants is 2.28 in level II centers compared with level III centers, and is unchanged (2.57) from 10 years earlier. Nearly 14% of very-low-birth-weight deliveries still occur at non-level III centers.
CONCLUSION: Changing patterns of perinatal regionalization have not improved outcome for inborn infants < 1500 gm except in level III centers. Attempts should be made to deliver very-low-birth-weight infants in level III centers. (Am J Obstet Gynecol 1998;178:131-5.)
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