Expansion of community-based perinatal care in California.
OBJECTIVE
In California, hospitals with Community Neonatal Intensive Care Units (NICUs) increased from 17 in 1990 to 52 in 1997. The purpose of this study was to investigate the effects of their growth on level-specific distribution of births, acuity, and neonatal mortality.


METHODS
A total of 4,563,900 infants born from 1990 to 1997 were analyzed by levels of care. We examined shifts in birth location and acuity. Neonatal mortality for singleton very-low-birth-weight (VLBW) infants without congenital abnormalities was used to assess differences in level-specific survival.


RESULTS
Live births at hospitals with Community NICUs increased from 8.6% to 28.6%, and VLBW births increased from 11.7% to 37.4%. Births and VLBW births at Regional NICUs decreased, whereas acuity was unchanged. There were no differences in neonatal mortality of VLBW infants born at Community or Regional NICU hospitals. Mortality for VLBW births at other levels of care was significantly higher.


CONCLUSIONS
The rapid growth of monitored Community NICUs supported by a regionalized system of neonatal transport represents an evolving face of regionalization. Survival of VLBW births was similar at Community and Regional hospitals and higher than in other birth settings. Reducing VLBW births at Primary Care and Intermediate NICU hospitals continues to be an important goal of regionalization. doi:10.1038/sj.jp.7210824
Gould
Jeffrey B
JB
University of California-Berkeley, Berkeley, CA 94720, USA.
Marks
Amy R
AR
Chavez
Gilberto
G
D001723:Birth Rate; D002140:California; D015331:Cohort Studies; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000706:statistics & numerical data; D015931:Intensive Care, Neonatal / Q000458:organization & administration* / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000458:organization & administration / Q000706:statistics & numerical data