A successful decade of regionalized perinatal care in Tennessee: the neonatal experience.
We hypothesized that successful implementation of regionalized perinatal care would result in early identification and antenatal referral of high-risk neonates, and also improved stabilization before and during transport of those transferred postnatally. We conducted a retrospective study of demographic characteristics and transport outcome in two defined groups of neonates transported to regional perinatal centers in Tennessee, one group (n = 218) from the first year of regionalization (1975), and a second group (n = 261) from the 12th year (1986). The percentage of outborn infants decreased, from 50% of all admissions in 1975 to 22% in 1986 (P = .005). Likewise, the percentage of low-birthweight neonates transported after birth decreased, from 59% of all transports to 32% (P = .002). The frequency of stabilization measures performed before and during transport increased between study years (intravenous line placement: 12% to 58%, P = .0001; assisted ventilation: 10% to 33%, P = .001). The incidence of complications during transport decreased between study years (cyanosis: 25% to 8%, P = .0001; hypothermia: 30% to 3%, P = .0001; acidemia: 33% to 13%, P = .011). Both transport-related mortality and neonatal mortality decreased between study years (2.8% to 0.8%, P = .043; 17% to 7%, P = .0001, respectively). We conclude that regionalization during its first decade has been successful in improving perinatal care in Tennessee as indicated by favorable changes in referral patterns and improved outcome of transported neonates.
Shenai
J P
JP
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232-2370.
Major
C W
CW
Gaylord
M S
MS
Blake
W W
WW
Simmons
A
A
Oliver
S
S
DeArmond
D
D
D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000458:organization & administration* / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000458:organization & administration* / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013714:Tennessee; D014187:Transportation of Patients / Q000706:statistics & numerical data*