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February 17, 2020

Delivering Neonates at High Risk in the Right Place: Back to the Future Again

Author Affiliations
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville
JAMA Pediatr. 2020;174(4):329-330. doi:10.1001/jamapediatrics.2019.6059

Regionalization of perinatal care has long been known to improve neonatal outcomes.1 The March of Dimes, in their original iteration of Toward Improving the Outcome of Pregnancy in 1976, strongly advocated for regionalized perinatal care and development of levels of neonatal care. In response, health care systems created regional perinatal networks to facilitate antenatal transfer of women at risk for preterm birth in the hopes of improving neonatal outcome and maternal care. In the 1990s, with the advent of managed care and expansion of Medicaid reimbursement, hospitals sought to control costs within systems. These changes led to an increase in the number of community neonatal intensive care units, which have outpaced local acuity and volume and contributed to the relative disintegration of regionalized perinatal networks.2 With variable definitions of levels of neonatal care, smaller neonatal intensive care units (NICUs) may not be able to offer the same resources as larger units, and lower daily volumes of NICU census can be associated with poorer outcomes.3 For women with pregnancies requiring very preterm deliveries, receiving care at the right hospital with the right resources can be a matter of survival or normal development for their children.

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