Changing patterns in regionalization of perinatal care and the impact on neonatal mortality

Am J Obstet Gynecol. 1998 Jan;178(1 Pt 1):131-5. doi: 10.1016/s0002-9378(98)70639-8.


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.

MeSH terms

  • Birth Weight / physiology
  • Female
  • Humans
  • Infant Mortality*
  • Infant, Newborn
  • Infant, Very Low Birth Weight / physiology
  • Intensive Care Units, Neonatal / standards
  • Linear Models
  • Missouri / epidemiology
  • Perinatal Care / standards*
  • Pregnancy
  • Pregnancy Outcome*
  • Regional Medical Programs / standards*