Perinatal regionalization and neonatal mortality in North Carolina, 1968-1994

Am J Obstet Gynecol. 2001 May;184(6):1302-7. doi: 10.1067/mob.2001.114484.


Objective: Our purpose was to analyze trends across time in the regionalization of low-birth-weight births and time trends for the association between regionalization and decreased neonatal mortality.

Study design: Data on 69,452 neonates with birth weights of 500 to 2000 g were obtained from electronic files of birth certificates. Hospitals' perinatal services were classified as level 1, 2, or 3 (level 3 refers to tertiary referral centers).

Results: The likelihood of birth outside level 3 hospitals decreased from 1968 to 1994, with an average annual decrease of 24% for infants weighing 500 to 1500 g and 20% for infants weighing 1501 to 2000 g. After 1974, birth in a hospital with level 3 services was associated with a lower risk of dying. The strength of this association increased in the 1990s.

Conclusions: In North Carolina the proportion of infants weighing <2000 g born outside a hospital with level 3 neonatal services declined from 1974 through 1994. After 1974, birth in a hospital with level 3 neonatal services was associated with lower neonatal mortality.

MeSH terms

  • Female
  • Hospitals
  • Humans
  • Infant Mortality*
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Intensive Care, Neonatal
  • Labor, Obstetric
  • North Carolina
  • Perinatal Care* / trends
  • Pregnancy
  • Regional Medical Programs*
  • Risk Factors