Infants born prematurely continue to make up almost 11.5% of the more than 4 million deliveries in the United States, with 1.4% of these deliveries occurring at a gestational age of 28 weeks or less.1 The work of Kastenberg et al,2 published in this issue of JAMA Pediatrics, adds to the extensive literature showing that delivery at a high-volume/high-level neonatal intensive care unit is associated with lower mortality and morbidity linked with premature birth.3-5 Given the high cost of delivering care to these infants, estimated at around $26 billion annually,1 neonatal intensive care has been the focus of efforts to regionalize neonatal care, defined as the development of a structured system of care “to improve patient outcomes by directing patients to facilities with optimal capabilities for a given type of illness or injury.”6 Thus, efforts to improve access to these hospitals focus on improved antenatal access to prenatal care; improved identification and transfer of mothers at risk for preterm delivery; and state health policies, such as certificate of need programs, to reduce expansion of neonatal services without justification of community need.7
Lorch SA. Ensuring Access to the Appropriate Health Care Professionals: Regionalization and Centralization of Care in a New Era of Health Care Financing and Delivery. JAMA Pediatr. 2015;169(1):11–12. doi:10.1001/jamapediatrics.2014.2468
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