title: Mode of delivery and level of neonatal care in Lombardy: a descriptive analysis according to volume of care.
abstract: BACKGROUND
  Using data from the Hospital Discharge data-base (SDO) and from the Certificate of Delivery Assistance data-base (CedAP) we analysed mode of delivery and neonatal care in public and private hospitals in Lombardy Region during 2012.
  
  
  METHODS
  In Lombardy a standard form is used to register all discharges from public or private hospitals (the SDO data-base which contained information on inpatient activity provided to each patient by any hospital or clinic included in the Regional Health System. Further, information on maternal characteristics and pregnancy outcome are available for all deliveries in CedAP data-base. We obtained data regarding all deliveries (mother discharge data-base M-SDO)and newborns discharge (N-SDO) and the CedAP data-base over the period January-December 2012 by the Lombardy Health Directorate. After linkage (using an anonymous key) of the three data-base using anonymized codes we obtained a data-base by the linkage of CedAP and N-SDO records, which includes, after elimination of incorrect codes, information on 90863 neonates and a data-base obtained by the linkage of CedAP and M-SDO records, which includes information on 90868 mother and deliveries. Using these data-base we have analysed mode of delivery and neonatal care in Lombardy according to the volume of care (VoC = number of delivery per year in the care unit).
  
  
  RESULTS
  In 2012, in Lombardy, less than 3% of newborns were born in hospitals reporting less than 500 deliveries/year and less than 30% in hospitals reporting < 1000 deliveries per year. Cesarean section rate was higher in units reporting less than 1000 deliveries/year (28.7% versus 27.5% in hospitals with more than 1000 deliveries/year). In hospitals reporting 500, 500-799, 800-999 deliveries/year the percentage of preterm births with gestational age <33 weeks ranged from 0.1% to 0.2%, but was 3.4% in hospitals reporting 2500 deliveries per year or more. A total of 0.6% of newborns weighing less than 1000 grams and 3.2% of newborns with birth weight between 1000 and 1499 grams was born in hospitals which reported 1000 deliveries or more.
  
  
  CONCLUSIONS
  This article provides an overview of delivery and neonatal care in the Lombardy Region with a focus on volume of care.
authors.affiliation: Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy. fabio.parazzini@unimi.it.|Dipartimento di Scienze Cliniche e di Comunità, Universita' di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milano, Italy. fabio.parazzini@unimi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Parazzini
authors.affiliation: Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy. sonia.cipriani@libero.it.
authors.forename: Sonia
authors.initials: S
authors.lastname: Cipriani
authors.affiliation: Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy. bulfoni@tiscali.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bulfoni
authors.affiliation: Dipartimento Materno Infantile, Ospedale Buzzi, Università degli Studi di Milano, Via Castelvetro 32, 20154, Milano, Italy. millabulfoni@hotmail.com.
authors.forename: Camilla
authors.initials: C
authors.lastname: Bulfoni
authors.affiliation: NICU Azienda Ospedaliera della Provinciale di Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy. r.bellu@ospedale.lecco.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellù
authors.affiliation: Dipartimento Materno-Infantile Azienda Provinciale Ospedaliera di Lecco, Milan, Italy. r.zanini@ospedale.lecco.it.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Zanini
authors.affiliation: Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy. fabio.mosca@mangiagalli.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D055815:Young Adult