title: Improved outcomes of transported neonates in Beijing: the impact of strategic changes in perinatal and regional neonatal transport network services.
abstract: BACKGROUND
  Infants born outside perinatal centers may have compromised outcomes due to the transfer speed and efficiency to an appropriate tertiary center. This study aimed to evaluate the impact of regional coordinated changes in perinatal supports and retrieval services on the outcome of transported neonates in Beijing, China.
  
  
  METHODS
  Information about transported newborns between phase 1 (July 1, 2004 to June 30, 2006) and phase 2 (July 1, 2007 to June 30, 2009) was collected. The strategic changes during phase 2 included standardized neonatal transport procedures, skilled attendants, a perinatal consulting service, and preferential admission of transported neonates to the intensive care unit of the tertiary care center. Data from phase 2 (after-strategic changes) were compared with those of phase 1 (the period of pre-strategic changes) after a 12-month washout period, especially regarding the reduction in mortality and selected morbidity.
  
  
  RESULTS
  There was a large increase in the number of transported infants in phase 2 compared with phase 1 (2797 vs. 567 patients). The average monthly rate of increase of transported infants was 383.3% (from 24 infants per month to 116 infants per month). The mortality rate of transported neonates reduced significantly from phase 1 to phase 2 (5.11% vs. 2.82%; P=0.005), particularly for preterm infants (8.47% vs. 4.34%; P=0.006). In addition, transported neonates during phase 2 had significantly decreased morbidities.
  
  
  CONCLUSIONS
  Regional coordinated strategies optimizing the perinatal services and transport of outborn sick and preterm infants to tertiary care centers improved survival outcomes considerably. These findings have vital implications for health outcomes and resource planning.
authors.affiliation: Newborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing, the People's Liberation Army, Beijing, 100700, China.
authors.forename: Xiang-Yong
authors.initials: XY
authors.lastname: Kong
authors.forename: Xiu-Xiang
authors.initials: XX
authors.lastname: Liu
authors.forename: Xiao-Yang
authors.initials: XY
authors.lastname: Hong
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Qiu-Ping
authors.initials: QP
authors.lastname: Li
authors.forename: Zhi-Chun
authors.initials: ZC
authors.lastname: Feng
mesh_terms: D002662:Child Health Services / Q000458:organization & administration*; D002681:China; D005260:Female; D006306:Health Surveys; D006785:Hospitals, University; D006801:Humans; D007035:Hypothermia / Q000401:mortality / Q000628:therapy; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality / Q000628:therapy*; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011446:Prospective Studies; D017694:Rewarming / Q000401:mortality; D016019:Survival Analysis; D014187:Transportation of Patients / Q000592:standards*; D016896:Treatment Outcome