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Why so little progress in regionalization of perinatal care when transport of high-risk neonates remains a substantial risk?

Journal of Perinatology volume 40, pages 357–358 (2020)Cite this article

The concept of transferring sick neonates to tertiary care centers originated in the 1930s after the establishment of the first Premature Infant Station by Dr Julius Hess at Sarah Morris Hospital in Chicago. Formalized policies recommending such transfers began in the late 1960s, led by Dr Joseph Butterfield. Working as a member of the Committee on Maternal and Child Care of the American Medical Association, Butterfield and a handful of leading pediatricians of the day wrote a one-page policy statement on regional perinatal care in October 1969 [1, 2]. These efforts evolved into the widely circulated policy statement by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in the 1976 March of Dimes report “Toward Improving the Outcome of Pregnancy.” [3]

Regionalization was soon widely adopted in the United States, in part due to regulatory efforts spearheaded by state certificate of need programs [4], and subsequent improvements in the morbidity and mortality of preterm infants were observed [5]. In recent decades, increases in patient volume and practicing neonatologists, advances in obstetric and neonatal care, and the desire of hospital systems to extend services have all contributed to the growth of smaller volume neonatal intensive care units (NICUs) caring for more complex infants, de-regionalizing perinatal care in many areas.

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References

  1. Butterfield L. The impact of regionalization on neonatal outcome. In: Smith GF, Vidyasagar D, editors. Volume 2 historical review and recent advances in neonatal and perinatal medicine. Evansville, IN: Mead Johnson Nutritional Division; 1980.

  2. American Academy of Pediatrics Pediatric History Center: Oral History Project: L Joseph Butterfield, Interviewed by Russel Nelson, June 24 1997.

  3. March of Dimes, Committee on Perinatal Health. Toward improving the outcome of pregnancy: recommendations for the regional development of maternal and perinatal health services. White Plains, NY: March of Dimes National Foundation; 1976.

  4. Simpson JB. State certificate-of-need programs: the current status. Am J Public Health. 1985;75:1225–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Holmstrom ST, Phibbs CS. Regionalization and mortality in neonatal intensive care. Pediatr Clin North Am. 2009;56:617–30.

    Article  PubMed  Google Scholar 

  6. American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics. 2012;130:587–97.

    Article  Google Scholar 

  7. Lasswell SM, Barfield WD, Rochat RW, Blackmon L. Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. J Am Med Assoc. 2010;304:992–1000.

    Article  Google Scholar 

  8. Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs BH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N. Engl J Med. 2007;356:2165–75.

    Article  CAS  PubMed  Google Scholar 

  9. Blackmon LR, Barfield WD, Stark AR. Hospital neonatal services in the United States: variation in definitions, criteria, and regulatory status, 2008. J Perinatol. 2009;29:788–94.

    Article  CAS  PubMed  Google Scholar 

  10. Lorch SA, Maheshwari P, Even-Shoshan O. The impact of certificate of need programs on neonatal intensive care units. J Perinatol. 2012;32:39–44.

    Article  CAS  PubMed  Google Scholar 

  11. Kroelinger CD, Okoroh EM, Goodman DA, Lasswell SM, Barfield WD. Designation of levels of care: a review of state regulatory and monitoring policies. J Perinatol. 2020; https://doi.org/10.1038/s41372-019-0500-0.

  12. Brasher M, Patil M, Hagan J, Suresh G. Mortality and morbidity in outborn extremely low birthweight neonates: A retrospective analysis. J Perinatol. 2020; https://doi.org/10.1038/s41372-019-0543-2.

    Article  PubMed  Google Scholar 

  13. Pai VV, Kan P, Gould JB, Hackel A, Lee HC. Clinical deterioration during neonatal transport in California. J Perinatol. 2020; https://doi.org/10.1038/s41372-019-0488-5.

  14. Guerrero JG. Amendment to a rule concerning the level of care designation for hospitals that provide neonatal and maternal care. Texas: Services DoSH; 2014.

  15. Okoroh EM, Kroelinger CD, Lasswell SM, Goodman DA, Williams AM, Barfield WD. United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement. J Perinatol. 2016;36:30–34.

    Article  CAS  PubMed  Google Scholar 

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  1. Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    Matthew J. Bizzarro & Patrick G. Gallagher

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  1. Matthew J. Bizzarro
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Correspondence to Matthew J. Bizzarro.

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Bizzarro, M.J., Gallagher, P.G. Why so little progress in regionalization of perinatal care when transport of high-risk neonates remains a substantial risk?. J Perinatol 40, 357–358 (2020). https://doi.org/10.1038/s41372-020-0600-x

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