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


METHODS
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.
Bode
M M
MM
Department of Pediatrics, University of North Carolina, Chapel Hill, USA.
O'shea
T M
TM
Metzguer
K R
KR
Stiles
A D
AD
D005260:Female; D006761:Hospitals; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007743:Labor, Obstetric; D009657:North Carolina; D018743:Perinatal Care / Q000639:trends; D011247:Pregnancy; D012041:Regional Medical Programs; D012307:Risk Factors