title: Perinatal care regionalization and low birth weight infant mortality rates in Alaska.
abstract: OBJECTIVE
  The purpose of this study was to determine the extent to which the failure of non-tertiary care hospitals to appropriately triage and refer pregnant women and newborns contributes to low birth weight infant death in Alaska.
  
  
  METHODS
  Birth certificates from 1993 to 1997 were reviewed for all 2809 infants who were born at less than 2500 g. Death certificates and maternal and infant medical charts were reviewed for all 168 infant deaths that occurred during this time.
  
  
  RESULTS
  Mother-infant pairs who received all care at Alaska's single tertiary care center had a lower mortality rate than those who received some care at a non-tertiary care center (risk ratio, 1.5; 95% confidence interval, 0.86-2.6). Despite this, only 4% of deaths among low birth weight infants (all <1500 g) were associated with care decisions at non-tertiary centers; none of these deaths involved intentional inappropriate retention of infants or mothers.
  
  
  CONCLUSIONS
  Further emphasizing perinatal care regionalization (including for infants 1500-2499 g birth weight) is unlikely to substantially decrease low birth weight infant mortality rates.
authors.affiliation: Alaska Division of Public Health, Anchorage 99524, USA. Brad_Gessner@health.state.ak.us
authors.forename: B D
authors.initials: BD
authors.lastname: Gessner
authors.forename: P T
authors.initials: PT
authors.lastname: Muth
mesh_terms: D000413:Alaska / Q000453:epidemiology; D006761:Hospitals / Q000592:standards; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000592:standards; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008499:Medical Records; D018743:Perinatal Care; D012017:Referral and Consultation / Q000592:standards; D012041:Regional Medical Programs