CAN AND SHOULD LEVEL-II NURSERIES CARE FOR NEWBORNS WHO REQUIRE MECHANICAL VENTILATION

Perinatal regionalization was conceived roughly 25 years ago to provid e centralized care for critically ill newborn infants. As for many 25- year-old concepts, the obligatory centripetal design of many regionali zation policies may need to be modified. This article presents the out comes of 408 surviving patients who required mechanical ventilation (1 36 born in one community hospital and 272 birthweight-matched infants horn in our tertiary center), and were cared for in our perinatal netw ork. Mechanical ventilation of a resident population of newborns at a community NICU appeared to be as effective as ventilatory care at a re gionalized tertiary neonatal intensive care unit, when assessed by com paring birthweight-matched populations for length of hospital stay, da ys on ventilator, and the need for home O-2. Some may still claim that every baby who requires mechanical ventilation must be transferred to a tertiary care center. In an era of heightened interest in health se rvices, health outcomes, and cost-effectiveness analysis, however, the authors believe that such claims will be subjected to increasing scru tiny. Our study represents a first attempt at determining the shape su ch scrutiny might take, and the sort of data analyses that may be requ ired to reformat a perinatal network.