CHANGING PATTERNS IN REGIONALIZATION OF PERINATAL-CARE AND THE IMPACTON NEONATAL-MORTALITY

OBJECTIVE: Our goal was to study changing patterns of low-birth-weight outcome over the past decade as deregionalized perinatal care has occ urred. 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 e valuate outcome. Regression models were constructed to compare outcome between levels of care. RESULTS: There has been a significant shift o f 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 cente rs compared with level III centers, and is unchanged (2.57) from 10 ye ars earlier. Nearly 14% of very-low-birth-weight deliveries still occu r 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.